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omnivores in Sweden1–3
Christel L Larsson and Gunnar K Johansson
100 Am J Clin Nutr 2002;76:100–6. Printed in USA. © 2002 American Society for Clinical Nutrition
DIET AND NUTRITIONAL STATUS OF ADOLESCENTS 101
method and blood samples to compare the results with those for The reported intakes of energy, nitrogen, sodium, and potas-
sex-, age-, and height-matched omnivores. sium were divided by the respective biological markers to detect
under- or overestimation in the DH (10). Measured energy
expenditure, nitrogen in urine divided by the excretion factor
SUBJECTS AND METHODS 0.81 (11), and sodium in urine (14–16) were used as biological
markers for reported energy, nitrogen, and sodium intakes,
Subjects respectively. The measured potassium in urine divided by the
Volunteers were recruited through advertising and visits to excretion factor—0.73 for lactovegetarians and 0.77 for omni-
schools in the Umeå area. The subjects had to be 16–20 y of age vores (15)—was used as the biological marker for potassium
and in good health, with no chronic diseases. Vegans were intake, because potassium in feces was not measured (14).
defined as people eating food of plant origin only and were
included in the study if they had consumed a vegan diet for ≥ 6 Nutritional assessments
mo and were planning to continue. Omnivores were defined as After the DH interviews, 3 fasting venous blood samples (1 wk
people eating food of both plant and animal origin and were apart) were taken. Hemoglobin, serum iron and ferritin, total-
included if they had consumed an omnivorous diet for their iron-binding capacity, transferrin saturation, and immune cell
entire life and were planning to continue this diet. In total, 65 concentrations were measured to enable classification of the sub-
vegetarians and 272 omnivores were interviewed. Thirty vegans jects’ iron status. Three blood samples were required to accu-
were eligible for inclusion. Thereafter, 30 omnivores were rately determine ferritin (17). Before each blood sample was taken,
matched by sex, age (± 6 mo), and height (± 3.5 cm). Each par- the subjects completed a short questionnaire about the last time
ticipant gave written, informed consent, and the study was they had eaten, infections, antibiotic treatment, dieting, and stress.
approved by the Research Ethics Committee of the Medical Fac- One fasting venous blood sample for measuring vitamin B-12
ulty, Umeå University, Umeå, Sweden. and folate in serum was taken at the same time as the first sam-
ple for iron-status classification.
TABLE 1
Validation of reported intakes of energy, nitrogen, sodium, and potassium in 30 vegans and 29 omnivores with the use of the doubly labeled water method
and 24-h urine collections1
Females Males
Vegans (n = 15) Omnivores (n = 15) Vegans (n = 15) Omnivores (n = 14)
2
EIrep/EEmea 0.84 ± 0.25 0.92 ± 0.19 0.87 ± 0.19 0.85 ± 0.16
(Nrep 0.81)/Nmea3 1.00 ± 0.32 0.98 ± 0.13 1.14 ± 0.27 1.04 ± 0.14
Narep/Namea4 0.78 ± 0.425 1.02 ± 0.21 1.02 ± 0.32 1.15 ± 0.26
(Krep 0.73 or 0.77)/Kmea6 0.90 ± 0.30 0.88 ± 0.19 1.02 ± 0.27 0.92 ± 0.18
1–
x ± SD. EI, energy intake; rep, reported; EE, energy expenditure; mea, measured; N, nitrogen. The Mann-Whitney U test was used for statistical com-
parisons between groups with different diets.
2
Reported energy intake of 32 subjects (16 vegans and 16 omnivores; 44% female) divided by energy expenditure, as measured by the doubly labeled
water method (13).
3
Reported nitrogen intake times the urinary excretion factor of nitrogen, 0.81 (11), divided by measured nitrogen in urine.
4
Reported sodium intake divided by measured sodium in urine.
5
Significantly different from female omnivores (P < 0.05).
6
Reported potassium intake times the urinary excretion factor of potassium, 0.73 for vegans and 0.77 for omnivores (15), divided by measured potas-
sium in urine.
(range: 0.7–4.0 y). All 30 vegans reported ethical reasons as rated fat, cholesterol, disaccharides, riboflavin, niacin, vitamin B-12,
their primary motivation for being vegan; 4 also mentioned vitamin D, calcium, phosphorus, zinc, and selenium than did
health reasons. omnivores (Tables 2 and 3). On the other hand, vegans obtained
a higher percentage of total energy from carbohydrates than did
TABLE 2
Dietary intake of macronutrients (excluding supplements) of 30 vegans and 30 omnivores1
Females Males
Energy and Recommended Vegans Omnivores Recommended Vegans Omnivores
macronutrients intake2 (n = 15) (n = 15) intake (n = 15) (n = 15)
Energy (MJ) — 8.93 ± 2.18 9.52 ± 1.97 — 12.2 ± 1.68 13.2 ± 2.00
Protein
(g) 47 55 ± 173 80 ± 18 51 72 ± 133 117 ± 21
(% of energy) 10–15 10 ± 1.03 14 ± 1.3 10–15 10 ± 1.03 15 ± 1.7
Fat
Total (g) 73 58 ± 234 75 ± 22 100 88 ± 15 100 ± 22
(% of energy) < 30 24 ± 5.43 29 ± 3.8 < 30 27 ± 2.6 29 ± 4.2
Saturated (g) < 24 15 ± 6.83 34 ± 10 < 33 25 ± 5.53 45 ± 9.3
Monounsaturated (g) 30 20 ± 124 27 ± 8.0 42 32 ± 6.5 37 ± 8.7
Polyunsaturated (g) 18 15 ± 6.53 8.6 ± 2.9 25 21 ± 3.83 12 ± 3.7
Carbohydrates
(g) 310 340 ± 79 310 ± 62 430 456 ± 62 424 ± 75
(% of energy) 55–60 66 ± 5.33 56 ± 3.8 55–60 63 ± 3.23 55 ± 4.0
Alcohol
(g) 14 3.9 ± 4.4 4.9 ± 7.0 19 2.1 ± 3.14 7.0 ± 7.9
(% of energy) < 4.5 1.4 ± 1.6 1.6 ± 2.3 < 4.5 0.5 ± 0.74 1.6 ± 1.8
Cholesterol (mg) — 2.3 ± 2.43 230 ± 76 — 2.1 ± 2.93 326 ± 58
Monosaccharides (g) — 65 ± 284 48 ± 16 — 64 ± 195 47 ± 17
Disaccharides (g) — 72 ± 29 5
100 ± 29 — 77 ± 203 137 ± 40
DISCUSSION often contain animal products and that the range of comparable
In accordance with other findings (19), male vegans weighed vegan products is limited. In contrast with previous findings
less and had a lower BMI than male omnivores; in contrast, no (21–24), the vegans and omnivores in our study consumed simi-
significant differences were seen between female vegans and lar amounts of alcoholic beverages. One exception was that male
omnivores in the present study. vegans had a lower intake of alcohol (g/d) than did male omni-
vores. The observation that vegans and omnivores had similar
Validity of the dietary assessment intakes of fruit and berries; white bread; pizza, pie, and pastries;
Energy intake was underreported (compared with measured chips and popcorn; soft drinks; and alcoholic beverages may
energy expenditure) by 14% of vegans and 12% of omnivores indicate that in this respect, young “ethical vegans” differ from
(Table 1; 13). Thus, subjects underreporting energy intake prob- the vegetarians who participated in previous studies, who proba-
ably had a higher than reported intake of nutrients; the opposite bly were more health conscious (24). Also, the high SDs of the
would be true for subjects overreporting energy intake. A possi- food intake values in the present study imply heterogeneous
ble explanation for the lower reported-to-measured sodium ratio intakes, especially among female vegans, indicating that some
of female vegans is that the salt content of vegan food items and young vegans have good food habits and others do not.
dishes in the food database is lower than is actually the case. Energy intake from snacks was higher than recommended
Potassium intake was underreported by 4% among vegans and (25); these findings confirm those of a dietary survey of 731 ado-
10% among omnivores, but even without adjusting reported lescents living in Umeå, Sweden (26). The lower intake of pro-
intake to account for underestimation, the potassium intake was tein among vegans than among omnivores was consistent with
above the lowest recommended intake level of the Nordic Nutri- results from previous studies (27–30). A low protein intake was
tion Recommendations for all subjects. reported to decrease urinary excretion of calcium (31–33), but a
recent study showed no association between intake of protein
Dietary intake and nutritional assessment and calcium absorption (34). The finding of lower intakes of
The higher intake of vegetables and legumes among vegans total and saturated fat and cholesterol among vegans than among
than among omnivores confirms the results of another study of omnivores was in agreement with findings from other studies
lactoovovegetarian adolescents (20). However, the lactoovoveg- (27–30). Together with higher intakes of polyunsaturated fat and
etarians in that study ate less legumes and nuts (78 ± 73 g/d) and dietary fiber among vegans, this has health benefits, at least as
vegetables (242 ± 147 g/d) and more sweets (149 ± 190 g/d) than far as ischemic heart disease is concerned.
did the vegans in the present study, suggesting a healthier diet The higher prevalence of supplement use among vegans than
among the Swedish vegans. A possible explanation for the lower among omnivores verifies previous results (24, 35). To prevent
intake of candy and chocolate and cake and cookies among female intakes that are lower than the average requirements of riboflavin
vegans than among female omnivores is that these food items (for males), vitamin B-12, vitamin D (for females), calcium, and
104 LARSSON AND JOHANSSON
TABLE 3
Dietary intake of vitamins and minerals (excluding supplements) of 30 vegans and 30 omnivores1
Females Males
Vitamins Average Vegans Omnivores Average Vegans Omnivores
and minerals requirement2 (n = 15) (n = 15) requirement (n = 15) (n = 15)
Vitamin A (RE) 700 966 ± 683 1169 ± 588 750 1045 ± 273 1226 ± 309
Thiamine (mg) 0.9 1.5 ± 0.8 1.5 ± 0.5 1.1 1.9 ± 0.6 2.2 ± 0.5
Riboflavin (mg) 1.1 1.1 ± 0.53 1.9 ± 0.7 1.4 1.2 ± 0.64 2.8 ± 0.7
Niacin (NE) 12 26 ± 8.43 32 ± 8.0 15 34 ± 7.84 48 ± 9.5
Vitamin B-6 (mg) 1 2.1 ± 0.7 2.0 ± 0.6 1.3 2.7 ± 0.5 2.8 ± 0.6
Vitamin B-12 (g) 1.4 0.0 ± 0.14 5.0 ± 2.5 1.4 0.1 ± 0.034 5.9 ± 1.5
Folate (g) 120 473 ± 187 4
226 ± 73 140 551 ± 1424 263 ± 42
Vitamin C (mg) 30 178 ± 995 104 ± 44 30 203 ± 614 96 ± 32
Vitamin D (g) 2.5 2.0 ± 1.3 4
5.1 ± 1.6 2.5 3.7 ± 1.24 7.7 ± 2.2
Vitamin E (-TE) 3.0 13 ± 5.74 7.3 ± 2.8 4.0 18 ± 3.14 9.2 ± 2.2
Iron (mg) 10 14 ± 4.5 3
11 ± 3.0 8.5 18 ± 3.1 18 ± 4.8
Calcium (mg) 600 538 ± 3504 1328 ± 372 600 517 ± 1584 1697 ± 444
Phosphorus (mg) 450 1025 ± 3044 1536 ± 378 450 1361 ± 2804 2176 ± 408
Magnesium (mg) — 443 ± 1205 325 ± 77 — 559 ± 963 457 ± 105
Sodium (mg) — 2580 ± 986 3040 ± 614 — 3797 ± 8563 4656 ± 1108
Potassium (mg) 1600 3460 ± 1240 3160 ± 921 1600 4200 ± 863 4100 ± 694
Zinc (mg) 5 7.8 ± 2.25 11 ± 2.6 6 10 ± 2.44 16 ± 3.3
Selenium (g) 30 10 ± 3.04 27 ± 7.6 35 12 ± 2.14 40 ± 8.2
1–
x ± SD. RE, retinol equivalent; NE, niacin equivalent; -TE, -tocopherol equivalent. The Mann-Whitney U test was used for statistical comparisons
selenium, the vegans were dependent on supplements. A study of 10–70 g/d because of low selenium content in the soil, and the
76 vegetarians (44 males, aged 27 y) showed that 73% of the lowest levels have been found in vegan diets comprising mostly
males had nonacceptable urinary riboflavin content, and the mean locally grown products (44). Supplementation of animal foods
intake of 50 subjects was 56% of the recommended allowance (36). with selenium has led to increased concentrations in meat, milk,
However, riboflavin need not be a problem in a well-planned and cheese (45, 46), indicating underestimated values of selenium
vegan diet because there are several vegan dietary sources, such content in these and possibly other food items included in the
as cornflakes, corn, spinach, and lentil sprouts (37). The vegans in
the present study had an intake of vitamin B-12 from diet that was
lower than the average requirement, and long-term vegans are TABLE 4
advised to include vitamin B-12–fortified foods or dietary sup- Iron-status, vitamin B-12, and folate assessment of female vegans and
plements in their diets (38). The differences in concentrations of omnivores1
vitamin B-12 and folate between the vegans and omnivores con- Vegans (n = 15) Omnivores (n = 15)
firm findings of other studies (39, 40). One of the 3 vegans with n (%)
low vitamin B-12 concentrations took B-12-supplements, indicat-
Early negative iron balance2 1 (6.6) 1 (6.6)
ing a failure in absorption rather than low intake. A possible
Iron depletion3 3 (20) 2 (13)
explanation is a lack or insufficient amounts of intrinsic factor Iron-deficient erythropoiesis4 1 (6.6) 1 (6.6)
needed for absorption (38, 41). Female vegans had dietary intakes Iron deficiency anemia5 1 (6.6) 3 (20)
of vitamin D that were lower than the average requirement, but Inadequate serum vitamin 1 (6.6) 0
the vitamin is also obtained via endogenous production when B-12 concentration6
skin is exposed to ultraviolet light. If exposure to sunlight is 1
No significant same-sex differences were found between vegans and
inadequate, which may be the case in northern Sweden between omnivores with the use of the Mann-Whitney U test. Two (13%) male
November and February, fortified foods such as soy drinks and vegans had inadequate serum vitamin B-12 concentrations. All other males,
some cereals or supplements of vitamin D may be needed for veg- both vegans and omnivores, had adequate blood concentrations of iron-
ans (37). Vegans had a lower intake of calcium than did omni- status variables and folate.
vores, which confirms previous findings for female vegans (42)
2
Plasma iron: < 21.5 mol/L; total-iron-binding capacity: 53.7–64.5 mol/L;
but is in contrast to those for male vegans (27). Vegans in the transferrin saturation: 30%; plasma ferritin: < 25 g/L (18).
present study relied on dietary supplements and calcium-fortified
3
Plasma iron: < 20.6 mol/L; total-iron-binding capacity: 64.5 mol/L;
transferrin saturation: 30%; plasma ferritin: < 20 g/L (18).
fluids to make up 35% of their calcium intake; omnivores 4
Plasma iron: < 10.7 mol/L; total-iron-binding capacity: 69.8 mol/L;
obtained 69% of their calcium from milk products. Vegans need transferrin saturation: < 15%; plasma ferritin: < 10 g/L (18).
to replace milk products with calcium-rich vegan foods such as 5
Plasma iron: < 7.2 mol/L; total-iron-binding capacity: 73.4 mol/L;
semolina, tofu, and fortified soy drinks and consume sizable serv- transferrin saturation: < 15%; plasma ferritin: < 10 g/L (18).
ings of leafy green vegetables such as kale and broccoli (37, 43). 6
Serum vitamin B-12: < 95 pmol/L. All subjects had adequate folate
The dietary intake of selenium in Sweden is estimated to be concentrations (< 3.4 nmol/L).
DIET AND NUTRITIONAL STATUS OF ADOLESCENTS 105
database. By eating products grown outside Sweden, such as 9. Bingham SA. The use of 24-h urine samples and energy expenditure
lentils, nuts, and cereals (47), grown on selenium-rich soil, vegans to validate dietary assessments. Am J Clin Nutr 1994;59(suppl):
may increase selenium intake. 227S–31S.
Female vegans had a higher iron intake (excluding supple- 10. Black AE, Bingham SA, Johansson G, Coward W. Validation of
dietary intake of protein and energy against 24 hour urinary N and
ments) than female omnivores, which does not support a previ-
DLW energy expenditure in middle-aged women, retired men and
ous finding (28). However, intake was similar when including post-obese subjects: comparisons with validation against presumed
supplements. Low iron status was as frequent among omnivores energy requirements. Eur J Clin Nutr 1997;51:405–13.
as among vegans, despite the vegans’ intake of nonheme iron 11. Bingham SA, Cummings JH. Urine nitrogen as an independent valida-
only, which has a lower absorption rate than does heme iron (48), tory measure of dietary intake: a study of nitrogen balance in individu-
and higher intakes of dietary fiber and possibly phytic acid, als consuming their normal diet. Am J Clin Nutr 1985;42: 1276–89.
which decrease the bioavailability of iron (8, 47). This result is 12. Johansson G, Bingham S, Vahter M. A method to compensate for
in agreement with one previous study (28) but not with others incomplete 24-hour urine collections in nutritional epidemiology
(29, 49). The prevalence of low iron status was similar to results studies. Public Health Nutr 1999;2:587–91.
of other Swedish studies on adolescents (50, 51). Only females 13. Larsson C, Westerterp W, Johansson G. Validity of reported energy
had low iron status because their intakes were lower and their expenditure and energy and protein intakes of Swedish adolescent
vegans and omnivores. Am J Clin Nutr 2002;75:268–74.
iron requirements higher than those of males (8). Iron bioavail-
14. Bingham S. The dietary assessment of individuals, methods, accu-
ability may be increased by combining iron intake with intake of
racy, new techniques and recommendations. Nutr Abstr Rev 1987;
food items high in vitamin C and by decreasing intake of phytic 57:705–42.
acid, through, for instance, yeast fermentation of whole-wheat 15. Johansson G, Callmer E, Gustafsson J-Å. Validity of repeated dietary
flours when baking bread, and by minimizing intake of the tan- measurements in a dietary intervention study. Eur J Clin Nutr
nins found in tea and coffee (37). 1992;46:717–28.
For 11 of the 20 individuals with nutrient intakes lower than 16. Fregly MJ. Attempts to estimate sodium intake in humans. In:
the average requirements, energy intake was validated with Horan MJ, Blaustein M, Dunbar JB, Dachadorian W, Kaplan NB,
34. Heaney R. Dietary protein and phosphorus do not affect calcium 43. Dwyer J. Vegetarianism. J Med 1980;3:660–1.
absorption. Am J Clin Nutr 2000;72:758–61. 44. Bruce Å. Swedish views on selenium. Ann Clin Res 1986;
35. Kirk SF, Cade JE, Barrett JH, Conner M. Diet and lifestyle charac- 18:8–12.
teristics associated with dietary supplement use in women. Public 45. Lindmark Månsson H. Näringsvärden i mjölk- och gräddprodukter.
Health Nutr 1999;2:69–73. (Nutrient content of dairy products.) Lund, Sweden: Swedish Dairy
36. Bergan J, Brown P. Nutritional status of “new” vegetarians. J Am Association, 1998 (in Swedish). (No. 49664.)
Diet Assoc 1980;76:151–5. 46. Johansson G. Näringsvärden på svenskt nötkött. (Nutrient content
37. Position paper on the vegetarian approach to eating. J Am Diet Assoc of Swedish beef.) Stockholm: Swedish Meat Association, 1997 (in
1980;77:61–9. Swedish). (No. G-37–96065.)
38. Position of the dietetic association: vegetarian diets. J Am Diet Assoc 47. Gibson RS. Content and bioavailability of trace elements in vege-
1993;93:1317–9. tarian diets. Am J Clin Nutr 1994;59(suppl):1223S–32S.
39. Abdulla M, Aly K, Andersson I, et al. Nutrient intake and health sta- 48. Hurrell R. Bioavailability of iron. Eur J Clin Nutr 1997;51(suppl):
tus of lactovegetarians: chemical analyses of diets using the dupli- S4–8.
cate portion sampling technique. Am J Clin Nutr 1984;40:325–38. 49. Donovan UM, Gibson RS. Iron and zinc status of young women
40. Helman AD, Darnton-Hill I. Vitamin and iron status in new vege- aged 14 to 19 years consuming vegetarian and omnivorous diets.
tarians. Am J Clin Nutr 1987;45:785–9. J Am Coll Nutr 1995;14:463–72.
41. Langley G. Vegan nutrition. 2nd ed. Surrey, United Kingdom: Litho 50. Samuelson G, Bratteby L-E, Berggren K. Dietary iron intake and
Techniques (Kenley) Ltd, 1995. iron status in adolescents. Acta Paediatr 1996;85:1033–8.
42. Alexander D, Ball MJ, Mann J. Nutrient intake and haematological 51. Bergström E, Hernell O, Lönnerdal B, Persson LÅ. Sex differences
status of vegetarians and age-sex matched omnivores. Eur J Clin in iron stores of adolescents: what is normal? J Pediatr Gastroen-
Nutr 1994;48:538–46. terol Nutr 1995;20:215–24.