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Vegetarian and vegan diets are increasing in the population, but the prevalence remains low (3 %). Vegetarians consume diary and eggs while vegans do not consume or use any animal derived products. Vegetarians have a low risk of deficiency except for iron deficiency with anemia in pre-menopausal women. Vegans should receive a mandatory vitamin B12 substitution because of an important risk of deficiency. Furthermore, vegans are at higher risk of iron and calcium deficiency with higher rates of osteoporotic fracture and iron deficiency anemia. Dietary advice is recommended, particularly for vegans, even though no clear recommendations can be found in the literature. These diets seem to be associated with a reduction in cardio-vascular risk factors, but this association remains to be confirmed.La prévalence des végétariens et véganes dans la population générale augmente, mais reste faible (3 %). Au contraire des véganes qui ne consomment que des produits d’origine végétale, les végétariens consomment des produits laitiers et des œufs. Les végétariens présentent peu de risque de carence mis à part un risque d’anémie ferriprive chez les femmes préménopausées. Les véganes, quant à eux, doivent être substitués systématiquement en vitamine B12 en raison d’un risque élevé de carence. Ils sont aussi plus à risque de carence en calcium et en fer, avec des taux de fracture ostéoporotique et de carence martiale plus élevés. Un suivi diététique est conseillé, en particulier pour les véganes, malgré l’absence de recommandations claires de la littérature. Ces régimes semblent améliorer de nombreux facteurs de risque cardiovasculaire mais ces effets restent à confirmer.

The vegan diet, although beneficial for adults in the prevention of metabolic diseases, raises questions about its benefits for a growing child : adequate caloric and protein intake, quality of essential amino acids, presence of essential fatty acids, inhibition of absorption of trace elements (including iodine, iron and zinc) and supply of various vitamins. Whereas vegan food is vitamin B12 deprived, the biggest challenge remains the vitamin B12 substitution in pregnant women, breastfeeding mothers and children at any age. Specific management by pediatricians using dietetic support and blood analyzes are required for children under vegan diet with respect of moral and ethical values related to this lifestyle choice.L’alimentation végétalienne, bien que bénéfique pour les adultes dans la prévention de maladies métaboliques, pose des questions quant à ses bénéfices pour un enfant en croissance : apports caloriques et protéiques suffisants, qualité en acides aminés essentiels et présence d’acides gras, inhibition de l’absorption des vitamines (notamment la D) et des éléments traces (par exemple, iode, fer, et zinc). Elle pose surtout la question de la supplémentation en vitamine B12 des futures mamans, des mères allaitantes et des enfants de chaque âge, alors que leur alimentation en est dépourvue. Des mesures particulières de surveillance diététiques et biologiques, ainsi qu’un accompagnement pédiatrique nutritionnel sont à proposer tout en respectant les valeurs morales et éthiques sous-jacentes à ce choix de vie.

La prévalence des végétariens et véganes dans la population générale augmente, mais reste faible (< 3 %). Au contraire des véganes qui ne consomment que des produits d'origine végétale, les végétariens consomment des produits laitiers et des œufs. Les végétariens présentent peu de risque de carence mis à part un risque d'anémie ferriprive chez les femmes préménopausées. Les véganes, quant à eux, doivent être substitués systématiquement en vitamine B12 en raison d'un risque élevé de carence. Ils sont aussi plus à risque de carence en calcium et en fer, avec des taux de fracture ostéoporotique et de carence martiale plus élevés. Un suivi diététique est conseillé, en particulier pour les véganes, malgré l'absence de recommandations claires de la littérature. Ces régimes semblent améliorer de nombreux facteurs de risque cardiovasculaire mais ces effets restent à confirmer.

Vegetarianism is a food consumption pattern. Vegetarianism, at large, includes several diets depending on exclusion's degree (partial or total) of animal products (meat or dairy). Among them we distinguish, according to the restriction order, flexitarian, semi-vegetarian, pesco-vegetarian, lacto-ovo-vegetarian, vegan food, raw food and fruit diets. These three last modes can extend to a lifestyle called veganism, which is defined as the lack of use of animal products in daily life (cosmetics, clothing, materials, etc.). This diversity can be explained by individual, psychological and motivational characteristics. Main reasons reported by individuals who have undertaken this feeding method are health and ethics. We observe differences in behaviors, attitudes and reactions about animals, disgust and justification of each diet vs. others' diets especially the omnivorous diet.

Over the past few years, we have observed increasing consumption of inappropriate plant milks as an alternative to infant milk formula. Some families believe that foods labeled as natural are the most healthy and an appropriate nutritional choice. However, their composition does not respect European recommendations. They are always hypocaloric and protein, vitamin, and mineral concentrations are inadequate. The aim of this study was to report severe nutritional complications after inappropriate plant milk consumption. Between 2008 and 2011, we studied severe nutritional deficiencies caused by consumption of plant milks bought in health food stores or online shops. Infants were identified in our centers and examined through medical history, physical examination, and laboratory testing. Nine cases of infants aged from 4 to 14 months were observed. In all cases, these milks were used as an alternative to milk formulas for supposed cow's milk allergy. At diagnosis, four patients were aged 6 months or less. They had received plant milk exclusively for 1-3 months. The beverages consumed were rice, soya, almond and sweet chestnut milks. In three cases, infants presented severe protein-calorie malnutrition with substantial hypoalbuminemia (20 g/L) and diffuse edema. In the other cases, the nutritional disorders were revealed by a refractory status epilepticus related to severe hypocalcemia (one case), growth arrest of both height and weight secondary to insufficient caloric intake (five cases), and severe cutaneous involvement (one case). Five children had severe iron deficiency anemia (70 g/L), three children had a very low 25-hydroxy vitamin D level (nutritional rickets), and two had severe hyponatremia (130 mmoL/L). Milk alternative beverages expose infants to severe nutritional deficiencies. Serious complications can occur. Early, exclusive, and extended use is riskier. These diseases are preventable, and parental education should be provided. Statutory measures forbidding their use in young infants should be organized to slow down the progress of this social trend.

A diet restricted to rice and boiled fruit and vegetables leads to vitamin C deficiency. We describe the third case, to our knowledge, of retinal hemorrhages related to scurvy. Reduced bilateral visual acuity in a 50-year-old patient was associated with macrocytic anemia, denutrition, and cutaneous ecchymoses. Oral vitamin C treatment provided subjective clinical improvement and regression of the retinal hemorrhages on fundus examination, with no side effects. Vitamin C plays an important role in collagen stability in vascular and bone walls.

We report on the case of an infant who was hospitalized because of failure to thrive, megaloblastic anemia, and delayed psychomotor development. He was 10 months old and had been exclusively breast-fed by his vegan mother. Investigations showed vitamin B(12) deficiency with hematocytopenia and pervasive developmental disorders as well as vitamin K and vitamin D deficiencies. The infant's mother presented the same deficiencies. Introduction of vitamin supplementation normalized the biological disorders, and the infant showed weight gain and neurological improvement. This case highlights that a vegan diet during pregnancy followed by exclusive breast-feeding can induce nutritional deficiencies in the newborn, with clinical consequences. Detecting mother and child vitamin deficiencies and preventing them is essential.

Vegan diet in lactating women can induce vitamin B12 deficiency for their children with risk of an impaired neurological development. A 9.5-month-old girl presented with impaired growth and severe hypotonia. She had a macrocytic anemia secondary to vitamin B12 deficiency. MRI showed cerebral atrophy. She was exclusively breastfed. Her mother was also vitamin B12 deficient, secondary to a vegan diet. She had a macrocytic anemia when discharged from the maternity. Vegan diet is a totally inadequate regimen for pregnant and lactating women, especially for their children. Prevention is based on screening, information and vitamin supplementation.

The dietary approach to cardiovascular disease often boils down to a few classical tips. However the data concerning the links between food and the health of the heart and arteries have never been as well substantiated as they are now. This paper reviews, in the various nutritional categories, the most recent findings concerning those nutritional factors influencing in one way or another the risk of cardiovascular disease. Each nutritional category includes foodstuffs which sometimes behave in very different ways. This "wide-ranging" approach to nutrition allows, besides repeating the basic messages (i.e. the importance of vegetables, the choice of fats, etc.), to counter some myths and to contemplate new ways of enabling positive, sound and personalized advice to be given.

FIBERS: A group of vegetarian subjects have been shown to have a lower risk of cancer of the prostate than a control group. But the exact role of food fiber remains to be determined because plant foods also have an antioxidant effect on their own. PLANT PRODUCTS AND EXTRACTS: A compound called PD SPEC has been showed to have antitumor effects both in vitro and in vivo. Evaluated in patients with a cancer escaping hormone control, the clinical response was a lower level of prostate specific antigen (PSA). SOYBEANS: Several studies have demonstrated the interesting properties of soybeans. No study has however been able to demonstrate the optimal dose per day. A prospective study is currently under way using a 40 g/day dose. OVERALL NUTRITIONAL APPROACH: Several studies are being conducted using a proposed diet where 15% of the total energy intake comes from fat (associated with a low saturated/unsaturated ratio), high fiber content (18 g/100 kcal) and 40 g daily soybean protein. Although large-scale studies with rigorous methodology are lacking, an overall nutritional approach could be an interesting strategy for the management of cancer of the prostate.

A vegan diet in the child and adolescent can induce severe bone sequelae by rickets and osteomalacia and megaloblastic anemia by cobalamin deficiency.A 15-year-old adolescent was hospitalized because of lameness and pallor. The lameness was explained by femoral epiphysiolysis caused by rickets with severe hypocalcemia. The pallor, jaundice and splenomegalia were due to cobalamin-deficiency megaloblastic anemia. A prolonged supplemental diet with calcium, vitamins D and B12 as well as orthopedic treatment stabilized the bone lesions. The megaloblastic anemia was cured by parenteral cobalamin. The adolescent and his brother were victims of a diet imposed by a cult and a lack of care due to their parents refusing that a vegan diet was the cause of the deficient pathology. Penal proceedings led to the incarceration of the parents and to the placement of the children.Deficiencies in calcium and vitamins D and B12 may be severe in a child's development with a vegan diet. This case report reveals the social and legal problems of an inappropriate diet in infancy imposed by parents who are followers of a fundamentalist church. Beyond the management of children in cults, health professionals have to prevent, screen and supplement the deficient diet.

Children have specific and increased nutritional requirements in comparison with adults. A rapid growth and an enhanced energy expenditure explain these main differences. Any diet deviation will expose more rapidly to a risk of nutritional deficiency with health consequences. Whenever a diet restriction is required for medical reasons, a particular attention must be paid to the feeding regimen in order to avoid any health problem and mainly growth retardation.

The protein requirements during infancy and childhood are the sum of both maintenance nitrogen needs and the amount of nitrogen required for growth. Exclusive breast feeding entirely meets these requirements, at least until 6 months of age, and the different approaches for estimating protein needs provide consistent values, which are strikingly steady for the first 12 months. From the mean protein requirement, it is possible to calculate the safe protein intake, eg, the amount of protein which should meet the requirements of every infant and child from 4 months to 3 years of age. Several expert committees concluded that the safe intake amounts to 15 g/d, a figure which now seems overestimated. In any case, the average intake of infants and toddlers is two to three fold higher than the safe protein intake in most developed countries. This holds true during later childhood and adolescence, the intakes exceeding the needs so much as to render pointless any discussion about amino acid requirements. Although the information about the long term effects of protein intakes in excess of the needs is scanty, the tight relationship between protein and fat intakes, particularly saturated ones, should not be overlooked and should prompt some caution when providing mothers with recommendations about feeding their infant.

The case of a 15-month-old, strictly breast-fed infant whose mother had been following a vegetarian diet for ten years is reported. The infant had severe megaloblastic anemia with an arrest in growth, hypotonia, and failure of psychomotor development. The very low levels of vitamin B12 in the infant's serum and mother's milk confirmed the diagnosis. Management of such cases consists in administration of vitamin B12 supplements, with a blood transfusion if needed. Other concomitant deficiencies should be looked for. The outcome is rapidly favorable. The patient reported here is now four years of age and has normal statural growth and psychomotor development.

People who refuse to eat meat animal products mostly adhere to vegetarianism, veganism, crudivorism or macrobiotism, But these food habits are only one part of life-style chosen for spiritual, ethic or hygienic and healthy motivations. Except vitamin B12 deficiencies these regimens do not produce other deficiencies if they are correctly followed and if the energy intake is in agreement with the RDA'S. They reduce the risks of metabolic diseases, coronaropathies, arterial hypertension, colon cancer, diverticular disease of the colon, kidney and gallstones. Nevertheless crudivorism and macrobiotism are associated with high risks of deficiencies especially in children and pregnant women.

In order to analyse the role of hypercarotenemia in amenorrhoea, we have studied the ovarian function of 20 patients presenting with hypercarotenemia (serum carotene greater than 5 mumol/l). 12 of these were complaining of secondary amenorrhoea (group I), 7 with a normal weight (group I A) and 5 with a weight below 85% of ideal weight (group I B). Another group of 8 patients had normal menstrual cycles and a body weight within normal limits (group II). Group I presented an ovarian insufficiency of hypothalamic origin with an increase in the FSH/LH ratio. The patients in group I A although of normal weight differed from group II by a history of important weight variations, strenuous sports activity and an essentially vegetarian diet, the most likely reason for their hypercarotenemia. The high carotene levels however do not seem to be directly responsible for the amenorrhoea, in view of the normal menstrual cycles of the patients in group II. Hypercarotenemia can be considered as a biologic marker of weight loss with fat mobilisation and low T3 levels. It can also be due to a vegetarian diet. The latter may be an aetiological factor in anovulation by increasing faecal excretion of oestrogens and thus decreasing blood levels of oestradiol particularly when associated with other compounding factors such as excessive physical activity, loss of weight or affective problems.

A case is presented of megaloblastic anemia with metabolic acidosis. The baby was eleven months old. She was strictly fed with human milk from a vegetarian mother. Baby's and mother's B 12 serum levels were low. Baby's weight and neurological development were retarded. Complications included acido-cetosis, coagulation disorder and liver disorder. All these problems were corrected by cobalamine supplementation. X-rays also disclosed bone demineralization.

The case of a young girl, born to a woman who was a vegetarian for 18 years, is presented. She had been exclusively breast-fed until the age of 6 months when a severe anemia was discovered with an extremely low hemoglobin level (1.9 g/100 ml). Her physical growth and psychomotor development had been normal until 3 months of age. Bone marrow showed megaloblastosis and the serum B12 level was low (45 ng/l). B12 levels were also decreased in both parents (110 and 105 ng/l) and in the mother's milk (12 ng/l). Treatment with parenteral B12 was successful. The importance of a careful dietetic inquiry in the case of an infant with megaloblastic anemia is stressed and likewise, as a preventive measure during all normal pregnancies.