Highlights
- Infants from vegan households showed growth patterns comparable to those from omnivorous households by 24 months of age.
- A statistically significant higher odds of underweight was observed in vegan infants during early infancy (first 60 days), which resolved over time.
- No significant differences in stunting or head circumference were observed between dietary groups at the two-year mark.
- The findings suggest that with adequate healthcare surveillance, plant-based diets can support normal physical development during the critical first 1,000 days of life.
Clinical Context: The Plant-Based Paradigm in Early Life
The prevalence of plant-based diets, including vegetarianism and veganism, has increased significantly across developed nations. While the health benefits for adults—such as reduced risks of cardiovascular disease and type 2 diabetes—are well-documented, the safety and adequacy of these diets during the rapid growth phase of infancy remain a subject of intense clinical debate. Concerns often center on the caloric density of plant-based foods, the bioavailability of essential micronutrients like iron, zinc, and vitamin B12, and the potential for growth faltering. Until recently, evidence was largely limited to small-scale studies or case reports of severe malnutrition associated with poorly planned restrictive diets. This study, leveraging a massive national database from Israel, provides high-level epidemiological evidence to address these concerns.
Methodological Framework: A National Surveillance Analysis
This retrospective cohort study utilized data from a national network of public family care centers (Tipat Chalav) in Israel, which provides health and developmental surveillance for over 95% of the country’s infant population. The study period spanned from January 1, 2014, to December 31, 2023. The researchers analyzed a total of 1,198,818 singleton births (gestational age ≥32 weeks, birth weight ≥1500 g). The primary exposure was the family dietary pattern—vegan, vegetarian, or omnivorous—as recorded by healthcare providers at least six months postpartum. The primary outcome was infant length, with secondary outcomes including weight, head circumference, and the prevalence of stunting (length-for-age z score < -2), underweight (weight-for-length z score 2).
Growth Outcomes and Nutritional Status
Early Infancy and the Underweight Phenomenon
At the outset of the study, 98.5% of infants were from omnivorous households, 1.2% from vegetarian households, and 0.3% from vegan households. In the early infancy period (the first 60 days of life), infants in the vegan group exhibited a higher adjusted odds ratio (aOR) for being underweight (aOR, 1.37; 95% CI, 1.15-1.63) compared to the omnivorous group. However, the absolute differences in length and length-for-age z-scores across all dietary groups were clinically minor, with World Health Organization (WHO) z-scores remaining ≤0.3. Stunting prevalence was nearly identical across all groups during this early stage, hovering around 7.0% to 7.1%.
Long-term Trajectories: Convergence at 24 Months
The longitudinal analysis, utilizing linear mixed-effects models, revealed a notable convergence in growth metrics as the infants aged. By 24 months, the prevalence of stunting had declined significantly across all cohorts: 3.1% in the omnivorous group, 3.4% in the vegetarian group, and 3.9% in the vegan group. Crucially, no statistically significant differences were found between the groups regarding stunting, underweight, or overweight status at the two-year mark. Mean differences for weight, length, and head circumference were clinically negligible (WHO z-score <0.2) and continued to diminish in adjusted models. This suggests that the initial lag in weight gain observed in vegan infants is a transient phenomenon that does not adversely affect long-term stature or cranial development.
Clinical Interpretation and Biological Plausibility
The transient nature of the early underweight risk in vegan infants may be attributed to several factors. In the context of Israel, where breastfeeding rates are high and public health counseling is robust, the transition to complementary feeding (solids) may allow for the introduction of nutrient-dense plant foods that support catch-up growth. Furthermore, the biological plausibility of these findings rests on the assumption that these plant-based families are likely highly health-conscious and adhere to supplementation guidelines (especially Vitamin B12 and iron) as mandated by national health protocols. The lack of difference in head circumference is particularly reassuring, as it serves as a proxy for brain growth and neurodevelopmental potential.
Expert Commentary and Practical Guidance for Clinicians
For pediatricians and family practitioners, these results provide a degree of reassurance when counseling parents who choose to raise their children on plant-based diets. However, the researchers emphasize that these findings are observed within the framework of a developed country with a strong health safety net. Clinicians should continue to prioritize the following:
1. Nutritional Counseling
Early and frequent consultation with a pediatric dietitian is essential to ensure that plant-based complementary foods are sufficiently calorie-dense and rich in essential fatty acids.
2. Targeted Supplementation
The risk of B12 deficiency remains the primary concern in veganism. Monitoring and supplementation should begin during pregnancy and continue throughout infancy.
3. Quality Over Category
The term ‘plant-based’ covers a wide spectrum of dietary quality. Practitioners should encourage whole-food, minimally processed sources rather than reliance on high-sugar or ultra-processed vegan alternatives.
Study Strengths and Limitations
The primary strength of this study is its unprecedented scale, involving over one million infants, which provides sufficient power to detect even subtle differences in growth outcomes. The use of standardized WHO growth charts and professional medical records minimizes the risk of self-reporting bias. However, limitations exist. As a retrospective cohort study, it cannot prove a direct causal link. The study also lacked detailed data on the specific quality of the diets (e.g., macronutrient breakdown) and the exact duration of breastfeeding versus formula use. Additionally, while the results are reassuring for physical growth, they do not provide data on other developmental milestones or long-term metabolic health.
Conclusion
In conclusion, infants raised in vegan and vegetarian households in a developed-world setting do not appear to be at significant risk for impaired physical growth compared to their omnivorous counterparts by age two. While an initial risk of underweight exists in the first few months, the subsequent normalization of growth trajectories highlights the resilience of infant development when supported by adequate healthcare surveillance. Future research should focus on the quality of plant-based diets and the specific role of nutritional counseling in optimizing both physical and cognitive outcomes in this growing population.
References
- Avital K, Fliss-Isakov N, Shahar DR, et al. Growth Trajectories in Infants From Families With Plant-Based or Omnivorous Dietary Patterns. JAMA Netw Open. 2026;9(2):e2557798.
- Baroni L, Goggi S, Battaglino R, et al. Vegan Nutrition for Mothers and Children: Practical Tools for Healthcare Professionals. Nutrients. 2018;11(1):5.
- Sutter DO, Bender N. Nutrient status and growth predictions in children on consumption of plant-based diets. Eur J Clin Nutr. 2021;75(9):1260-1264.
- World Health Organization. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. 2006.
