Vegan and other plant-based diets are becoming increasingly popular in the paediatric age group. There is limited evidence in the current medical literature to determine whether a vegan diet is adequate for children, since the currently available society position papers are based on narrative reviews and expert opinion. Updated evidence-based recommendations are needed to guide clinical practice. This position paper presents findings from a literature review performed using a systematic search strategy, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We analyzed the current evidence on the effect of vegan diet compared to omnivorous diet on body growth, nutritional adequacy and laboratory biomarkers in infants, children and adolescents. Observational studies, cohort studies and clinical trials published over the last 15 years in MEDLINE/PubMed, EMBASE and Cochrane Library were retrieved. Our position paper aims to update the evidence for or against the adequacy of a vegan diet in infants, children and adolescents and to provide evidence-based recommendations. A total of 10 articles were accepted and included in the final review, providing information on approximately 1500 children following a vegan diet. Several articles assessed more than one outcome: seven addressed body growth, five evaluated nutritional adequacy and five examined laboratory biomarkers. To complement the primary data, three systematic reviews and meta-analyses were also included. Current evidence is inconclusive to determine whether a strictly vegan diet supports normal childhood growth, although no significant differences in height or body mass index z-scores were observed compared to omnivorous peers. We recommend that dietary intake, growth and nutritional status should be regularly monitored in vegan children. Focusing on dietary intakes (e.g., protein, omega-3, calcium and iron) and ensuring supplementation with specific micronutrients, including vitamin B12, is essential during paediatric age when following a strict vegan diet. Clinical research, well-designed prospective studies and high-quality trials are required to address current research gaps.

Celiac Disease Research Center Faculty of Medicine and Health Technology Tampere University Tampere Finland

Children's Hospital Helsinki University Hospital Helsinki Finland

Departiment of Health Science University of Milan Milan Italy

Department of Neonatal Intensive Care Oslo University Hospital Oslo Norway

Department of Neonatology Kepler University Hospital Linz Austria

Department of Paediatric Gastroenterology Great Ormond Street Hospital for Children NHS Foundation Trust London London UK

Department of Paediatrics University Hospital Motol Prague Czech Republic

Department of Pediatric Research University of Oslo Oslo Norway

Department of Pediatrics Regina Margherita Children Hospital University of Turin Turin Italy

Department of Pediatrics Tampere University Hospital Wellbeing Services County of Pirkanmaa Tampere Finland

Department of Pediatrics Vittore Buzzi Children's Hospital University of Milan Milan Italy

Metabolic Disease Unit Department of Pediatrics Vittore Buzzi Children's Hospital University of Milan Milan Italy

Neonatology Hospital La Paz Institute for Health Research IdiPAZ Universidad Autónoma de Madrid Madrid Spain

Paediatric Gastroenterology Erasmus MC Sophia Children's Hospital Rotterdam the Netherlands

Serra Hunter Fellow Pediatric Nutrition Research Unit Universitat Rovira i Virgili IISPV Tarragona Spain

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