Response to Letter to the Editor: Iron, zinc, and iodine in vegan youth

We appreciate the opportunity to address concerns1 regarding the article, Nutritional and growth concerns of vegetarian diets in children.2 Iron deficiency remains one of the most common nutrient deficiencies in all children. We agree that medical providers should consider monitoring iron status in children following vegetarian or vegan diets3 and provide dietary guidance on iron intake and limiting inhibitors of iron absorption. The American Academy of Pediatrics (AAP) recommends universal screening for anemia and iron deficiency around 12 and 18 months of age.4 However, beyond this, data are insufficient to recommend a specific monitoring schedule in vegetarian/vegan children. While studies have shown decreased zinc intake in vegetarian individuals, data on serum zinc levels and clinical zinc deficiency are mixed with poor correlation of intake with serum zinc levels.5 In children and women during pregnancy and lactation, there is insufficient evidence to determine whether true clinical zinc deficiency is more common in vegetarians.6 Studies have found relatively lower levels of iodine in children on vegetarian diets, especially in regions without universal salt iodization programs.7, 8 In the study mentioned by Drs. Gilley and Diab, less than 10% of omnivorous, vegan, and vegetarian children met the Recommended Daily Intake (RDI) of iodine based on dietary intake alone.7 Thus, medical providers should counsel families based on their unique risks, regional supplementation patterns, and dietary intake. Our review article2 is meant to enable healthcare providers to discuss the health impacts of vegetarian diets in children with timely referral to a nutrition specialist or registered dietitian. The authors declare no conflict of interest.