JOURNALOF ADOLESCENTHEALTH1996;18:292-300
ORIGINAL ARTICLE
Dietary Intakes of Adolescent Females Consuming
Vegetarian, Semi-vegetarian, and Omnivorous Diets
URSULA M. D O N O V A N , Ph.D., A N D R O S A L I N D S. GIBSON, Ph.D.
Purpose: To determine the energy and nutrient intakes
of some omnivorous and vegetarian female adolescents
to compare their risk for nutrient inadequacies.
Methods: A convenience sample of 78 lacto-ovo-vege-
tarians (LOV), 15 semi-vegetarians (SV), and 29 omnivo-
rous (OM) females aged 14-19 years completed three-day
weighed records from which mean intakes and major
food sources of energy, nutrients, and dietary fiber (as
nonstarch polysaccharides (NSP)) were calculated.
Results: Mean daily intakes for energy and most nutri-
ents were comparable for the three groups although LOV
had higher intakes (p < 0.01) of NSP, copper, and
manganese. Lacto-ovo-vegetarians consumed (g/d) less
dairy products, flesh foods, and sweets but more le-
gumes, nuts, and vegetables. Major food sources were
cereal products for energy, most nutrients, NSP, dairy
products for calcium, and fruits and vegetables for vita-
min C. More LOV and SV had energy intakes less than
two-thirds of Canadian recommendations, and higher
probability estimates of inadequacy for protein, calcium,
iron, zinc, and riboflavin than OM. Fewer LOV (35%)
than SV (53%) and OM (41%) had diets with less than
30% energy from fat.
Conclusions: LOV and SV were more at risk for nutri-
ent inadequacies than OM, although about 33% of OM
were also at risk for inadequate intakes of iron and zinc.
KEY WORDS:
Vegetarianism
Food habits
Adolescence
Dietary intake
Nutrition
From the Division of Applied Human Nutrition, University of
Guelph, Guelph, Ontario, NIG 2W1.
Address requests to: Ursula M. Donovan, Ph.D., Education and
Research Division, Middlesex-London Health Unit, 50 King St., London,
Ontario, Canada N6A 5L7.
Manuscript accepted May 21, 1995.
1054q39X/96/$15.00
SSDI1054-139X(95)00133-D
The rapid acceleration in physical growth and devel-
opment during adolescence creates a high demand
for energy and nutrients, making a wise choice of
diet essential. Unfortunately, female adolescents of-
ten have poor dietary habits that may result in
inadequate intakes of energy and some nutrients
(1-4).
Recently, interest in vegetarian dietary patterns
has increased, in part, because lower intakes of fat
and red meat and higher intakes of dietary fiber have
been shown to reduce the risk of certain chronic
degenerative diseases in adult life (5). In general,
such vegetarian dietary patterns in adulthood, if well
balanced, are compatible with a healthy nutritional
status (5). However, whether the nutrient intakes of
vegetarian adolescents are adequate has received
little attention. Therefore, we have compared the
reported energy and nutrient intakes of a group of
Canadian female adolescents consuming vegetarian
and omnivorous diets to assess the risk of nutrient
inadequacies when adolescents intentionally limit
their consumption of flesh foods.
Methods
Subjects
One hundred and twenty-two females from South-
ern Ontario aged 14-19 years (mean _+ SD, 17.9 _+ 1.5
years), were recruited for the study via publicity in
the media, at natural health food stores, high schools,
universities, and in other high visibility areas. The
study protocol was approved by the Human Ethics
Committee of the University of Guelph. Written
consent was obtained after the nature of the study
had been fully explained to all of the participants.
©Societyfor AdolescentMedicine,1996
Publishedby ElsevierScienceInc.,655 Avenueof the Americas,New York,NY10010
April 1996
Written parental permission was also obtained for
participants less than 16 years of age.
Respondents were classified into three categories
on the basis of their food consumption patterns
assessed via a food frequency questionnaire. The
categories were: (1) 78 lacto-ovo-vegetarians (LOV),
defined as individuals who consumed red meat (i.e.,
beef, pork or lamb products), poultry, and fish less
than once per month but included dairy a n d / o r egg
products in their diet; (2) 15 semi-vegetarians (SV),
who consumed red meat less than once a month, but
included poultry a n d / o r fish in their diets more than
once a month; and (3) 29 omnivores (OM) who
consumed a mixed diet. All but two LOV consumed
dairy products; however, 44 of the participants in the
LOV and SV groups consumed eggs less than once a
month except in baked goods or as minor ingredients
in mixed dish recipes.
Respondents in the LOV and SV groups had
followed their diets for a mean (+_ SD) of 4.7 + 5.3
years (range 7 months-19 years); only 10 participants
had excluded red meat from their diets for less than
1 year. The mean (+ SD) ages of each group were
17.7 + 1.4 years for LOV, 18.4 ___1.8 years for SV, and
18.2 + 1.4 years for OM, respectively. Forty-seven
percent of participants were 17 years or younger, and
53% were 18 years or older.
Vitamin and mineral supplements were not
widely used by this group of adolescents; 65% of
LOV, 87% of SV, and 66% of OM reported no use of
supplements. Regular use of supplements (at least
3-4 times/week) was reported by 22% of LOV, 7% of
SV, and 24% of OM. Of the participants, LOV used
multivitamin and mineral supplements most com-
monly (n = 13), followed by vitamin C a n d / o r a
vitamin B complex (n = 5), and iron supplements
(n = 2). Omnivorous participants used mainly vita-
min C a n d / o r a vitamin B complex (n = 6) and
multivitamin and mineral supplements (n = 2); no
OM reported using iron supplements. One SV took
multivitamin and mineral supplements plus calcium,
magnesium, iron, and zinc.
Descriptive characteristics and current health sta-
tus of the participants, as well as length of time and
reasons for choosing a vegetarian diet, were obtained
via a health and lifestyle questionnaire, administered
by personal interviews. Details about the anthropo-
metric data collection have been reported elsewhere
(6). Weight-for-age and weight-for-height of the par-
ticipants was compared to NHANES I and NHANES
II reference data (7).
DIETARYINTAKESOF ADOLESCENTVEGETARIANS 293
Dietary Assessment
Dietary data were collected via weighed food
records completed by each subject on three consec-
utive days, one of which was a weekend day. Partic-
ipants were instructed individually on the correct
procedures to record accurately and completely the
type and quantity of all foods and liquids consumed,
and to provide product names, method of food
preparation, recipes for prepared food items, as well
as time and place of food consumption (8). Each
participant was provided with a metric scale (Han-
son Dietetic Scale, Model 1440, Shubuta, MI) with
which they weighed the edible portion of all foods
and beverages consumed. On the rare occasion when
it was not possible to weigh food, common house-
hold measures were used to estimate the portion size
consumed. Completed food records were reviewed
with each participant by a nutritionist for accuracy
and completeness. Food records were then coded
and analyzed by computer using the University of
Guelph nutrient intake program with nutrient values
derived from the condensed Canadian Nutrient File
(9), USDA Agricultural Handbook No. 8 (10), and
other food composition tables (11,12). Nutrient com-
position data for vegetarian foods such as textured
vegetable protein products were obtained directly
from food manufacturers and the literature; data for
composite dishes were calculated from recipes and
labels provided by the participants. Values for di-
etary fiber, reported as nonstarch polysaccharides
(NSP), were obtained from McCance & Widdow-
sons' The Composition of Foods (12,13).
Mean daily intakes of energy, protein, fat, NSP,
calcium, phosphorus, iron, zinc, copper, manganese,
thiamine, riboflavin, niacin, and vitamin C were
calculated from the coded three-day weighed food
records for each dietary group. All data are based on
dietary intakes only and do not include vitamin and
mineral supplements. Intakes are expressed per day
and per megajoule (MJ) (4.2 MJ = 1000 kcal) to
account for differences in total energy intakes. The
adequacy of energy and nutrient intakes was as-
sessed by comparison with two-thirds of the Recom-
mended Nutrient Intakes for Canadians (RNI) (14),
or with the United States Recommended Dietary
Allowances (RDA) (15) for those nutrients for which
there are no Canadian recommendations (i.e., copper
and manganese). Probability analysis was applied to
selected nutrient intakes to calculate the proportion
of individuals likely to have intakes below their own
individual requirements (16). Foods were also cate-
294 DONOVAN AND GIBSON JOURNAL OF ADOLESCENT HEALTH Vol. 18, No. 4

Table 1. Mean (_+ SD) Intakes of Energy, Dietary Fiber (as NSP), and Selected Nutrients (per Day and per MJ*) of
Vegetarian (LOV), Semi-Vegetarian (SV), and Omnivorous (OM) Adolescent Females
per Day per MJ
LOV SV OM LOV SV OM
Nutrient (n 78) (n - 15) (n = 29) (n 78) (n - 15) (n = 29)
Energy (kJ) 7164 + 1944 7157 _+2599 7286 _+ 1733 -- -- --
Protein (g) 51 ± 16 54 + 23 58 + 19 7 ± 2* 8+2 8 -- 2*
Fat (g) 63 -+ 21 56 _+23 63 + 21 9 -+ 2 8+3 9- 2
Dietary fiber (g)~ 14 ± 6* 13 + 6 10 + 4~ 2 -+ 1' 2 -+ 1 1 _+ 0*
Calcium (mg) 733 _~ 335 760 ± 413 747 + 242 102 ± 38 107 -+ 49 102 ± 25
Phosphorus (mg) 1186 _+397 1123 _+ 492 1283 _+464 171 + 57 158 _+44 174 _+45
Iron (mg) 11.0 _+3.7 11.3 _+ 6.2 11.7 _+4.1 1.6 + 0.5 1.6 _+ 0.5 1.6 + 0.4
Zinc (mg) 6.7 + 2.1 7.3 _+ 4.3 7.8 +_3.0 1.0 _+0.3 1.0 _+ 0.4 1.1 + 0.3
Copper (mg) 1.4 _+0.5* 1.2 _+ 0.5 1.1 + 0.3~ 0.20 ± 0.06* 0.16 + 0.04~: 0.15 ± 0.03~
Manganese (rag) 4.1 + 1.8' 3.2 ± 1.9 2.8 + 1.2¢ 0.58 ± 0.23* 0.43 + 0.13~ 0.39 ± 0.14'
Thiamin (rag) 1.3 -+ 0.5 1.5 ± 1.0 1.4 ± 0.6 0.18 -+ 0.06 0.20 + 0.08 0.19 ± 0.07
Riboflavin (rag) 1.3 + 0.5 1.4 _+ 0.6 1.7 _+ 1.0 0.19 --- 0.05 0.20 + 0.07 0.23 _+ 0.12
Niacin (NE) 21.5 + 7.8* 24.5 + 10.5 27.3 ± 10.2' 3.0 ± 0.8* 3.5 + 1.0 3.7 _+ 1.0*
Vitamin C (mg) 144 ± 101 131 _+ 99 110 + 64 20 ± 12 17 ÷ 11 15 + 8
* MJ = Megajoule; 4.2 MJ = 1000 kcalories.
** Values within a row with different symbols are significantly different (p < 0.01).
Dietary fiber as nonstarch polysaccharide (NSP).

g o r i z e d i n t o s e v e n m a j o r f o o d g r o u p s to d e t e r m i n e
t h e m o s t i m p o r t a n t f o o d s o u r c e s of e a c h n u t r i e n t .
Statistical Analysis
S t a t i s t i c a l a n a l y s i s w a s p e r f o r m e d u s i n g t h e Statisti-
cal A n a l y s i s S y s t e m (SAS). D i e t a r y d a t a w e r e t e s t e d
for n o r m a l i t y b y t h e S h a p i r o - W i l k test a n d l o g -
t r a n s f o r m e d , if n e c e s s a r y . T h e s t a t i s t i c a l l y s i g n i f i c a n t
d i f f e r e n c e s in r e p o r t e d n u t r i e n t i n t a k e s a m o n g t h e
three dietary groups were determined using analysis
of v a r i a n c e ( A N O V A ) ; p o s t h o c c o m p a r i s o n s w e r e
m a d e u s i n g t h e T u k e y H S D t e s t statistic. Statistical
s i g n i f i c a n c e o f d i f f e r e n c e s in c o n t r i b u t i o n s of m a j o r
f o o d g r o u p s to n u t r i e n t i n t a k e s a n d a m o n g a n t h r o -
pometric measurements were determined using the
n o n p a r a m e t r i c K r u s k a l - W a l l i s test (17). D i f f e r e n c e s
i n f r e q u e n c y d i s t r i b u t i o n s of w e i g h t - f o r - a g e a n d
w e i g h t - f o r - h e i g h t w e r e e x a m i n e d u s i n g F i s h e r ' s ex-
act test. Tests w e r e c o n s i d e r e d s i g n i f i c a n t at p < 0.05.
Results
T h e L O V a n d SV a d o l e s c e n t s c o n s i s t e d of 33 S e v e n t h
D a y A d v e n t i s t s (35%) a n d 60 " n e w " v e g e t a r i a n s
(65%). O f t h e f o r m e r , 78% f o l l o w e d v e g e t a r i a n di-
e t a r y p a t t e r n s for r e a s o n s m a i n l y r e l a t e d to h e a l t h .
The "new" vegetarians were primarily motivated by
ethical and/or environmental considerations, such
as a n i m a l s l a u g h t e r a n d t h e i n e f f i c i e n t u s e of w o r l d
r e s o u r c e s for m e a t p r o d u c t i o n (60%); o n l y 15% c i t e d
h e a l t h - r e l a t e d r e a s o n s , 20% c o n s u m e d n o m e a t b e -
c a u s e of t a s t e p r e f e r e n c e s , a n d 5% c u r r e n t l y l i v e d in
a vegetarian family.
U s i n g t h e c l a s s i f i c a t i o n s y s t e m of F r i s a n c h o (1990)
(7), w e i g h t - f o r - a g e a n d w e i g h t - f o r - h e i g h t w e r e
w i t h i n n o r m a l r a n g e (i.e., 1 5 t h - 8 5 t h p e r c e n t i l e s ) for
t h e m a j o r i t y of t h e s e a d o l e s c e n t s . O f t h e t o t a l p a r t i c -
i p a n t s , o n l y s e v e n h a d w e i g h t - f o r - a g e a n d 18 h a d
w e i g h t - f o r - h e i g h t b e l o w t h e 15th p e r c e n t i l e .
Energy and Selected Nutrient Intakes
T h e r e p o r t e d m e a n ( + SD) d i e t a r y i n t a k e s of e n e r g y ,
N S P , a n d n u t r i e n t s ( p e r d a y a n d p e r MJ) for t h e t h r e e
g r o u p s a r e p r e s e n t e d in T a b l e 1. I n g e n e r a l , m e a n
n u t r i e n t i n t a k e s ( p e r d a y ) a n d n u t r i e n t d e n s i t y of t h e
d i e t s ( p e r MJ) w e r e c o m p a r a b l e a m o n g t h e t h r e e
g r o u p s , w i t h t h e e x c e p t i o n of t h e L O V g r o u p w h o
h a d l o w e r (p < 0.01) m e a n i n t a k e s of n i a c i n a n d
h i g h e r (p < 0.01) m e a n i n t a k e s of N S P , c o p p e r , a n d
m a n g a n e s e t h a n t h e O M a n d in s o m e cases, t h e SV
diets. P r o t e i n d e n s i t y of t h e L O V d i e t s w a s a l s o
l o w e r t h a n in t h e O M d i e t s (p < 0.01), a n d t h e m e a n
p r o t e i n i n t a k e of t h e O M g r o u p w a s t h e o n l y o n e t h a t
m e t r e c o m m e n d a t i o n s . I n all g r o u p s , m e a n i n t a k e s of
e n e r g y , iron, a n d z i n c w e r e l o w e r ; a n d m e a n i n t a k e s
of c a l c i u m , p h o s p h o r o u s , v i t a m i n C a n d B v i t a m i n s
w e r e h i g h e r t h a n C a n a d i a n r e c o m m e n d a t i o n s (14).
T a b l e 2 p r e s e n t s t h e p r o p o r t i o n s of i n d i v i d u a l s (as
%) w i t h i n t a k e s less t h a n t w o - t h i r d s of t h e C a n a d i a n
R N I (14), a n d t h o s e l i k e l y to h a v e i n t a k e s b e l o w t h e i r
April 1996 DIETARY INTAKES OF ADOLESCENT VEGETARIANS 295

Table 2. Percent of Vegetarian (LOV), Semi-Vegetarian (SV), and Omnivorous (OM)

Adolescent Females with Inadequate Apparent Intakes of Energy and Selected
Nutrients Determined as Less Than Two-Thirds of Canadian Recommended Intakes
(RNI), and by Probability Analysis
<z/,~ RNI PA*
LOV SV OM LOV SV OM
Nutrient (n = 78) (n = 15) (n = 29) (n = 78) (n = 15) (n = 29) RNI*
Energyt 37 53 24 . . . .
Protein ~ 15 27 10 31 39 23 47
Calcium 22 20 17 32 33 20 700
Phosphorus 3 7 7 6 18 8 850
I r o n tt 26 47 24 48 55 33 12
Zinc ~ 37 47 21 100 91 38 9
Thiamin 4 0 7 0 0 1 0.8
Riboflavin 10 13 7 2 13 0 1.1
Niacin 4 0 3 0 1 0 15
Vitamin C 3 20 0 3 20 3 30
* Probability analysis (16).
t Canadian recommended nutrient intakes for 16-18 year old females (14).
Energy requirements estimated as 0.19, 0.17, and 0.15 MJ/kg body weight for 13-15 year olds,
16-18 year olds, and 19-24 year old females, respectively (14).
Protein requirements estimated as 0.95, 0.88, and 0.86 g/kg body weight for 13-15 year olds,
16-18 year olds, and > 19 year old females, respectively (14).
ILProbability analysis for iron adjusted for 10% (LOV and SV), and 12.5% (OM) absorption (14).
Probability analysis for zinc adjusted for 10% (LOV), 15% (SV), and 35% (OM) absorption (38).

o w n r e q u i r e m e n t s , assessed b y p r o b a b i l i t y analysis a n d cereal p r o d u c t s in the diets is n o t e w o r t h y as t h e y

(16). Of the three g r o u p s , m o r e SV h a d intakes b e l o w w e r e the p r i m a r y s o u r c e s of e n e r g y , protein, fat,
t w o - t h i r d s of the R N I for e n e r g y , protein, iron, zinc, NSP, p h o s p h o r o u s , iron, zinc, c o p p e r , m a n g a n e s e ,
riboflavin, a n d v i t a m i n C; a n d b e l o w their o w n thiamine, riboflavin, a n d n i a c i n for all g r o u p s . D a i r y
i n d i v i d u a l r e q u i r e m e n t for protein, calcium, p h o s - p r o d u c t s w e r e the p r i m a r y d i e t a r y s o u r c e of calcium;
p h o r o u s , iron, riboflavin, a n d v i t a m i n C b y probabil- fruits a n d v e g e t a b l e s w e r e the m a j o r s o u r c e of vita-
ity analysis. m i n C. Differences existed a m o n g the n u t r i e n t con-
I n the LOV, SV, a n d O M g r o u p s , 59%, 67%, a n d tributions (as %) of the s e v e n m a j o r f o o d g r o u p s for
90%, respectively, h a d c o p p e r intakes b e l o w the
s u g g e s t e d "safe a n d a d e q u a t e " r a n g e of 1.5-3.0
m g / d set b y the U n i t e d States F o o d a n d N u t r i t i o n
B o a r d (15); n o p a r t i c i p a n t s h a d a m e a n intake w h i c h
e x c e e d e d this range. M e a n d a i l y m a n g a n e s e intakes Table 3. Percent Energy from Fat, Protein, and
Carbohydrate in Diets of Vegetarian (LOV), Semi-
r a n g e d f r o m 3.7-17.6 m g p e r d a y , w i t h 10%, 27%, Vegetarian (SV), and Omnivorous (OM) Adolescent
a n d 28% of LOV, SV, a n d OM, respectively, r e c e i v i n g Females
m a n g a n e s e intakes b e l o w the F o o d a n d N u t r i t i o n
LOV SV OM
B o a r d "safe a n d a d e q u a t e " r a n g e of 2.0-5.0 r a g / d ; (n = 78) (n = 15) (n = 29)
31% of LOV, 20% of SV, a n d 3% of O M e x c e e d e d this
Fat
limit.
Mean-+ SD 33_+6 30 +9 32_+7
T h e m e a n p e r c e n t a g e s of e n e r g y f r o m fat a n d Median 32 29 33
c a r b o h y d r a t e (Table 3) w e r e similar for all g r o u p s Range 17-45 12-42 20-45
a n d w i t h i n the r a n g e r e c o m m e n d e d b y H e a l t h a n d Protein
W e l f a r e C a n a d a (14), w i t h a w i d e v a r i a t i o n a m o n g Mean _+ SD 12 _+3* 13 -+ 3 13 +- 3*
Median 12 13 14
i n d i v i d u a l s . Of the participants, 35% of LOV, 53% of
Range 6-23 7-21 7-18
SV, a n d 41% of O M h a d diets w i t h less t h a n 30% of Carbohydrate
e n e r g y f r o m fat. Mean _+ SD 58 _+7 59 _+11 55 + 8
The p e r c e n t a g e c o n t r i b u t i o n of s e v e n m a j o r f o o d Median 58 60 55
g r o u p s to n u t r i e n t intakes for each d i e t a r y g r o u p are Range 44-78 37-82 40 -72
g i v e n in Tables 4 a n d 5. The i m p o r t a n c e of b r e a d s * Significantly different (p < 0.03).
296 DONOVAN AND GIBSON JOURNAL OF ADOLESCENTHEALTH Vol. 18, No. 4

Table 4. Percent Contribution of Seven Major Food Groups to Energy, Protein, Total Fat, Dietary Fiber (as NSP),
Calcium, Iron, Zinc, and Phosphorus Intakes of Vegetarian (LOV), Semi-Vegetarian (SV), and Omnivorous (OM)
Adolescent Females
Energy Protein Fat Dietary Fiber* Calcium Iron Zinc Phosphorus
Food Group LOV SV OM LOV SV OM LOVSVOM LOV SV OM LOV SV OM LOVSVOM LOVSVOM LOV SV OM
Dairy 13 16 14 24 26 22 19 20 17 1 2 1 45 53 52 3 5 3 23 26 21 26 33 28
products
Eggs 1 1 1 2 2 1 1 2 1 0 0 0 1 1 0 l 1 1 1 2 1 1 2 0
Legumes and 10t 5' 2* 19' 9* 3t 17t 9' 4' 9t 6* 3' 6t 2* 1' 12' 4' 2* 15t 7t 4' 14+ 5* 2'
nuts
Meat, poultry O* 5' 9* O* 14' 23~ O* 7* 15~ O* 3* 1 0 2 2 O* 3* 10§ 10' 8* 21-~ 0+ 7* 10*
and fish
Cereal 40 41 44 39 36 41 31 36 36 46* 48* 61' 28 25 34 52* 57 65* 40 40 40 32 28 32
products
Fruit and 21' 21' 16' 14' 11 7* 12 11 10 42* 38 33* 14' 11 7* 26* 22 15' 15' 12 9* 17' 15 11'
vegetables
Miscellaneous I 14 11 14 3 3 3 20 16 16 1 4 1 5 6 4 6 7 4 5 4 4 10' 10' 18'
* Dietary fiber as nonstarch polysaccharide (NSP).
t, § Values within a row with different symbols are significantly different (p < 0.05).
!lIncludes fats, oils, beverages, alcohol, foods primarily sugar, condiments, and sauces.

each of the three diet groups. Lacto-ovo-vegetarians
received a higher p r o p o r t i o n of all nutrients (p <
0.05) f r o m l e g u m e s a n d nuts and m o r e protein, NSP,
calcium, iron, zinc, p h o s p h o r o u s , copper, v i t a m i n C,
thiamine, riboflavin a n d niacin (p < 0.05) f r o m fruits
a n d vegetables. O m n i v o r e s received a higher pro-
portion of all nutrients (p < 0.05) except NSP, cal-
cium, a n d m a n g a n e s e f r o m meat, p o u l t r y and fish
products; and m o r e NSP, iron, copper, thiamine,
riboflavin a n d v i t a m i n C f r o m cereal products. Semi-
v e g e t a r i a n s received m o r e (p < 0.05) copper, m a n g a -
nese, a n d v i t a m i n C f r o m milk products.
Table 6 c o m p a r e s the m e a n (_+ SD) intake ( g / d ) of
each m a j o r food g r o u p for the LOV, SV, a n d O M
groups, a n d Ontario adolescent females in the N u -
trition C a n a d a s u r v e y (18). Lacto-ovo-vegetarians
c o n s u m e d less dairy products, meat, p o u l t r y a n d
fish, a n d sweets, a n d m o r e l e g u m e s a n d nuts, and
vegetables t h a n O M (p < 0.02). All three dietary
g r o u p s c o n s u m e d substantially less d a i r y a n d flesh
foods, b u t m o r e sweets (including soft drinks), cereal
products, and fruits than their c o u n t e r p a r t s in the
Nutrition C a n a d a Survey in the early 1970s.
Discussion
I n f o r m a t i o n on the food c o n s u m p t i o n patterns a n d
dietary intakes of v e g e t a r i a n adolescents is limited,
despite a notable increase in the p o p u l a r i t y of vege-
tarianism a m o n g this age g r o u p (19,20). Some of our
g r o u p of LOV a n d SV adolescents w e r e Seventh D a y
A d v e n t i s t s (35%); the majority w e r e " n e w " vegetar-
ians. The f o r m e r a d o p t a lacto-ovo-vegetarian diet
for religious a n d health reasons, w h e r e a s m o s t of o u r
" n e w v e g e t a r i a n s " w e r e m o t i v a t e d b y ethical a n d
e n v i r o n m e n t a l considerations. By contrast, m o s t
adults are attracted to v e g e t a r i a n i s m for its a p p a r e n t
health benefits (20). Such a g e - d e p e n d e n t differences
in factors m o t i v a t i n g v e g e t a r i a n i s m m a y i m p a c t on
the nutritional quality of diets of v e g e t a r i a n adoles-
cents c o m p a r e d to adults.
Energy, Macronutrient, and NSP Intakes
O v e r 80% of our adolescents h a d r e p o r t e d a v e r a g e
e n e r g y intakes b e l o w the a v e r a g e e n e r g y require-
m e n t for adolescent females (14), as f o u n d in earlier
studies of this age g r o u p in N o r t h America (1,21).
This is u n f o r t u n a t e because w h e n e n e r g y intakes are
low, it is difficult to achieve a d e q u a t e intakes of all
the essential nutrients (14). The total a v e r a g e g r a m s
of food c o n s u m e d w a s lower t h a n r e p o r t e d in an
earlier s t u d y of o m n i v o r o u s C a n a d i a n adolescents
(18). L o w e r intakes of dairy products, meat, poultry,
fish, eggs, fats, and oils (Table 6) w o u l d contribute to
the increased risk of i n a d e q u a t e intakes of energy,
protein, calcium, iron, a n d zinc (Table 2).
Diets of v e g e t a r i a n adults generally h a v e a l o w e r
fat content than that of o m n i v o r e s (22). In o u r
adolescent group, fat intakes (as % of energy) did not
differ a m o n g the three diet g r o u p s (Table 3), a n d
w e r e l o w e r t h a n earlier reports (35-40%) (18,23),
a p p r o x i m a t i n g the current C a n a d i a n r e c o m m e n d a -
tions (less than 30% e n e r g y as fat) (14). Such low fat
April 1996 DIETARY INTAKES OF ADOLESCENT VEGETARIANS 297

Table 5. Percent Contribution of Seven Major Food Groups to Copper, Manganese, Vitamin C, Thiamine, Riboflavin,
and Niacin Intakes of Vegetarian (LOV), Semi-Vegetarian (SV), and Omnivorous (OM) Adolescent Females
Copper Manganese Vitamin C Thiamine Riboflavin Niacin
Food Group LOV SV OM LOV SV OM LOV SV OM LOV SV OM LOV SV OM LOV SV OM
Dairy products 3* 9' 6* 1" 3* 2 3* 11' 4* 7 8 9 29 36 33 14 14 12
Eggs 0 0 0 0 0 0 0 0 0 0 0 0 3 3 1 1 1 1
Legumes and 22* 11' 4* 12" 7 4* 3* 1 0t 12" 6 1' 9* 2* 1' 17" 9* 4t
nuts
Meat, poultry 0* 3 5~ 0* 2* 1 0* 0* 3* 0* 3* 8~ 0* 3* 8~ 0* 12* 22~
and fish
Cereal 34* 36* 49* 52 57 57 1" 1" 6t 51" 57 64* 36* 34* 45* 45 46 49
products
Fruits and 30* 28 23* 20 22 16 93* 87* 87* 27* 21 17' 18" 15 8* 19" 15 10'
vegetables
Miscellaneous ~ 10 11 ll 15 10" 19' 0 1 0 1 3 1 3 4 3 3 3 3
* *$ Values within a row with different symbols are significantly different at p < 0.05.
Includes fats, oils, beverages, alcohol, foods primarily sugar, condiments, and sauces.

i n t a k e s w e r e a t t r i b u t e d to the s m a l l p r o p o r t i o n of
e n e r g y f r o m flesh foods. E v e n the i n t a k e of flesh
f o o d s for o u r O M g r o u p w a s low, o n l y a b o u t 50% of
t h a t r e p o r t e d i n t h e N u t r i t i o n C a n a d a s u r v e y (18).
I n s t e a d , cereal p r o d u c t s f o l l o w e d b y d a i r y p r o d u c t s
w e r e the m a j o r s o u r c e s of fat for all t h r e e diet g r o u p s
(Table 4).
A p p r o x i m a t e l y o n e - t h i r d of b o t h o u r LOV a n d SV,
a n d o n e - q u a r t e r of the O M h a d p r o t e i n i n t a k e s
b e l o w their o w n r e q u i r e m e n t s (Table 2), a h i g h e r
e s t i m a t e t h a n a n earlier r e p o r t of C a n a d i a n o m n i v o -
r o u s a d o l e s c e n t f e m a l e s (24). I n d e e d , the a v e r a g e
p r o t e i n i n t a k e s of all the diet g r o u p s w e r e e v e n l o w e r
t h a n t h o s e r e p o r t e d for b o t h a d o l e s c e n t s c o n s u m i n g
m i x e d diets (1,2,23,24) a n d a d u l t v e g e t a r i a n s
(20,22,25).
P r o t e i n c o m p l e m e n t a t i o n , w h e r e b y a m i x t u r e of
p r o t e i n f r o m v a r i o u s s o u r c e s p r o v i d e s all e s s e n t i a l
a m i n o acids i n s u f f i c i e n t q u a n t i t y , a l t h o u g h of con-
c e r n for s o m e v e g e t a r i a n s (5), w a s n o t a p r o b l e m for
o u r L O V a n d SV b e c a u s e 26% a n d 42% of d i e t a r y
protein was provided by dairy products and animal
p r o d u c t s , r e s p e c t i v e l y (Table 4). N e v e r t h e l e s s , be-
c a u s e r e p o r t e d e n e r g y i n t a k e s for m a n y of o u r a d o -
l e s c e n t s w e r e so l o w (Table 2), p r o t e i n m a y b e
c a t a b o l i z e d for e n e r g y , e x a c e r b a t i n g the risk of p r o -
t e i n d e f i c i e n c y for t h o s e L O V a n d SV w i t h diets l o w
i n p r o t e i n , e s p e c i a l l y i n v i e w of the h i g h p r o t e i n
r e q u i r e m e n t s d u r i n g a d o l e s c e n c e for o p t i m a l g r o w t h
a n d d e v e l o p m e n t (i.e., 0 . 8 8 - 0 . 9 5 g / k g / d for a d o l e s -
c e n t f e m a l e s v e r s u s 0.86 g / k g / d for a d u l t w o m e n )
(14).
D i e t a r y fiber i n t a k e s are r e p o r t e d h e r e as NSP,
a n d are l o w e r t h a n e s t i m a t e s b a s e d o n total d i e t a r y

Table 6. Mean (_+ SD) Daily Intakes of Nine Food Groups (Grams) by Vegetarian (LOV), Semi-Vegetarian (SV), and
Omnivorous (OM) Adolescents in Comparison to Intakes of Adolescent Females in Nutrition Canada Survey (NC)
Food Group LOV SV OM NC*
Dairy products (g) 221 -- 182t 327 _+2125 315 ÷ 180~: 563
Meat, poultry, fish and eggs (g) 8 -+ 9t 36 -+ 225 73 ÷ 57~ 118
Legumes and nuts (g) 78 + 73t 45 _+55 12 ± 19~ 21
Cereal products (g) 282 + 116 288 + 149 304 _+ 142 239
Fruits (g) 341 + 246 403 -+ 338 292 _+ 199 287
Vegetables (g) 242 _+ 147t 159 _+ 1215 108 -+ 805 169
Fats and oils (g) 16 +_ 12 11 _+9 11 _+ 10 17
Sweets (g)ll 149 _+190t 129 _+ 118t 214 _+ 1615 29~
Miscellaneous** 102 + 217 65 -+ 114 60 ± 161 --
Mixed dishes and soupstt -- -- -- 112
* Mean intakes by 12-19 vear old females in Ontario (18).
ts~ Values within the same row with different symbols are significantly different (p < 0.02).
I Includes foods primarily sugar, regular soft drinks, and sugar-free soft drinks.
Includes foods primarily sugar, tea, coffee, alcoholic beverages, and soft drinks.
** Includes alcohol, condiments, sauces, coffee, and tea.
++Includes mixed dishes, soups, condiments, and miscellaneous items not classified elsewhere.
298 DONOVANAND GIBSON
fiber because the Englyst method used for NSP does
not include lignin and removes starch completely
before analysis (26). The mean NSP intakes of our
LOV and SV were higher than that of the OM (Table
1) but within the range of NSP values (11-18 g / d )
reported by others for most mixed diets (26,27).
Mineral Intakes
Average calcium intakes reported here were compa-
rable with (3,4) or lower (1,23,24) than those reported
for female adolescents consuming mixed diets. Cal-
cium intakes below dietary recommendations have
been identified in many young females consuming
mixed diets (1,4) and are of concern. Consumption of
adequate dietary calcium during adolescence con-
tributes to optimal peak bone mass and reduces risk
for osteoporosis in later life (14,28).
In our study, more LOV and SV than OM had
calcium intakes below their own requirements (Table
2), perhaps because adolescents tend to replace milk
at meals by soft drinks (29). In our adolescent diets,
soft drinks were a major contributor to the sweets
food group (Table 6).
Mean phosphorous intakes of our adolescents
were slightly higher than those reported elsewhere
(3,4), and exceeded those of calcium. Therefore, the
average Ca:P ratio in each dietary group was 1:1.8
and within the range associated with normal calcium
absorption and utilization for 73% of the adolescents.
Nevertheless, 27% of the adolescents had Ca:P ratios
above 1:2, which, if representative of their usual
diets, may be undesirable (30).
In our study, the mean dietary iron intakes for all
three groups were similar to those reported for
omnivorous adolescent females in North America
(1-4,24,31). Adult vegetarian women have diets with
a higher iron density than our adolescents (20,32); no
comparative data exist for vegetarian adolescents.
Approximately 40% of iron in flesh foods is in the
highly bioavailable heine form (33). Because our OM
group had a low intake of flesh foods, they contrib-
uted less of the total dietary iron than that of other
omnivorous adolescents (i.e., 20-30%) (4,18). In-
stead, plant-based foods provided most (80-90%) of
the total dietary iron for all three diet groups. Plant-
based foods contain nonheme iron that is poorly
available, and often have high levels of phytate,
dietary fiber, oxalic acid, and polyphenols, compo-
nents that inhibit nonheme iron absorption (33).
The Canadian RNI for iron is based on a mixed
diet of high iron bioavailability containing generous
amounts of meat, poultry, and fish, or foods contain-
JOURNALOF ADOLESCENTHEALTHVol. 18, No. 4
ing high amounts of ascorbic acid (14). In our study,
although diets contained limited amounts of flesh
foods, intakes of vitamin C in all three diet groups
were high (Table 1). Nevertheless, approximately
one-half of the adolescents in both the LOV and SV
groups as well as one-third in the OM groups had
iron intakes below their estimated requirements (Ta-
ble 2). Low intakes of heme iron and high intakes of
nonheme iron have been associated with biochemical
evidence of impaired iron status among other studies
of vegetarian women (20,34,35).
Absorption of dietary zinc depends on the content
and bioavailability of zinc in the diet. Zinc bioavail-
ability is markedly reduced by phytate (36), espe-
cially in the presence of high intakes of calcium (37).
The major food sources of zinc for the OM group
were breads and cereals (40%), and flesh foods and
dairy products (42%) (Table 4). Absorption of zinc
seems to be approximately 30% from mixed diets
that are low in phytate and supply 10-12 mg Z n / d
(37). As the diets of our OM had a lower zinc content
(i.e., 7.8 mg/d), we used 35% for the fractional
absorption of zinc, as used for the Canadian RN1 for
a mixed diet (14). For our LOV and SV diets, we
estimated fractional zinc absorption to be 15% and
20% (38), respectively, because the zinc content of
these diets was largely provided by plant-based
foods (70% for LOV; 59% for SV; Table 4). Applying
these estimates for fractional zinc absorption, a very
high proportion of our adolescents, especially in the
LOV and SV groups, were at risk to zinc intakes
below their own requirements (Table 2). However,
by careful selection of plant-based foods rich in zinc
but relatively low in phytate, our adolescent vege-
tarians can increase the content and bioavailability of
zinc in their diets so that mean zinc intakes (per day
and per MJ) are no longer below the range reported
for many adolescent and adult women consuming
vegetarian and omnivorous diets (2-4,32,39-41).
Many of our adolescents, especially in the OM
group, had copper intakes below 1.5 rag/d, the "safe
and adequate" level set by the United States Food
and Nutrition Board (15), a trend noted by others for
adolescent females (3,4,40,41). Of the three groups,
the LOV had a significantly higher mean copper
intake (per day and per MJ) than that of OM, in
accordance with an earlier study of vegetarians (25);
plant-based foods were the major food sources of
copper (Table 5).
The mean daily intakes of manganese for all three
groups were higher than those reported for young
females elsewhere (4,42); LOV had the highest man-
ganese density, as reported by other investigators
April 1996
(25), w h i c h w a s a t t r i b u t e d to t h e i r h i g h p r o p o r t i o n of
e n e r g y f r o m p l a n t - b a s e d f o o d s (Table 4) (25).
Vitamin Intakes
M e a n d a i l y i n t a k e s of t h i a m i n , n i a c i n , r i b o f l a v i n , a n d
v i t a m i n C ( p e r d a y a n d p e r MJ) for all t h r e e a d o l e s -
cent groups were adequate, a finding consistent with
t h a t r e p o r t e d for a d u l t v e g e t a r i a n s (20,22,43) a n d
o m n i v o r o u s a d o l e s c e n t s (1-3,23,24). N e v e r t h e l e s s , of
t h e SV, 13% a n d 20% w e r e at r i s k to i n a d e q u a t e
i n t a k e s of r i b o f l a v i n a n d v i t a m i n C, r e s p e c t i v e l y .
I n t a k e s of n i a c i n w e r e s i g n i f i c a n t l y h i g h e r in t h e O M
c o m p a r e d to t h e L O V g r o u p , d e s p i t e s i m i l a r e n e r g y
i n t a k e s , b e c a u s e of d i f f e r i n g f o o d choices. V i t a m i n C
i n t a k e s w e r e e i t h e r c o m p a r a b l e o r h i g h e r t h a n in-
t a k e s p r e v i o u s l y r e p o r t e d for this a g e g r o u p (1-3,23),
a t r e n d t h a t m a y e n h a n c e a b s o r p t i o n of n o n h e m e
iron.
I n s u m m a r y , o u r a d o l e s c e n t s t e n d e d to f o l l o w
v e g e t a r i a n i s m for h u m a n i t a r i a n r a t h e r t h a n h e a l t h
r e a s o n s . G r o u p s w i t h all t h r e e t y p e s of d i e t s h a d l o w
i n t a k e s of e n e r g y a n d flesh f o o d s ; c e r e a l s w e r e t h e
major source of energy and most nutrients with the
e x c e p t i o n of c a l c i u m a n d v i t a m i n C. A s a r e s u l t , t h e
p r e v a l e n c e of i n a d e q u a t e i n t a k e s of p r o t e i n , c a l c i u m ,
i r o n , a n d z i n c w a s h i g h , e s p e c i a l l y in t h e L O V a n d
SV g r o u p s , w h e r e a s i n t a k e s of p h o s p h o r o u s , t h i a -
mine, riboflavin, niacin, and vitamin C were gener-
a l l y s a t i s f a c t o r y i n r e l a t i o n to t h e d i e t a r y r e c o m m e n -
d a t i o n s . Y o u n g w o m e n of t h i s a g e g r o u p w h o f o l l o w
vegetarian diets must consume well-planned diets,
a d e q u a t e in e n e r g y a n d w i t h a h i g h n u t r i e n t d e n s i t y
to f u r n i s h t h e i r n u t r i e n t r e q u i r e m e n t s for g r o w t h a n d
development.
The authors wish to thank all the participants for their co-
operation and commitment to this study. Financial support for
this work was provided by Kellogg Canada, Ltd., and the Natural
Sciences and Engineering Research Council of Canada.
References
1. Health and Welfare Canada: Nutrition Canada National Sur-
vey Report. O~tawa: Bureau of Nutritional Sciences, Depart-
ment of Health and Welfare, 1973.
2. Greger JL, Higgins MM, Abernathy RP, et al. Nutritional
status of adolescent girls in regard to zinc, copper, and iron.
Am J Clin Nutr 1978;31:269.
3. McCoy H, Kenny MA, Kirby A, et al. Nutrient intakes of
female adolescents from eight southern states. J Am Diet
Assoc 1984;84:1453.
4. Pennington JAT, Young BE. Total Diet Study nutritional
elements, 1982-1989. J Am Diet Assoc 1991;91:179.
DIETARY INTAKES OF ADOLESCENT VEGETARIANS 299
5. American Dietetic Association. Position of the American Die-
tetic Association: Vegetarian diets. J Am Diet Assoc 1993;93:
1317.
6. Donovan UM, Gibson RS. Iron and zinc status of female
adolescents consuming vegetarian and omnivorous diets. J
Am Coll Nutr 1995; (In press).
7. Frisancho RF. Anthropometric Standards for the Assessment
of Growth and Nutritional Status. Ann Arbor: University of
Michigan Press, 1990.
8. Gibson RS. Principles of Nutritional Assessment. New York:
Oxford University Press, 1990.
9. Health and Welfare Canada. Condensed Canadian Nutrient
File. Ottawa: Bureau of Nutritional Sciences, Department of
National Health and Welfare, 1988.
10. Consumer & Food Economic Institute. Composition of Foods:
raw, processed and prepared. Agriculture Handbook No. 8,
1-21. Washington, D.C.: Agricultural Research Service, US
Department of Agriculture, 1976-1991.
11. Pennington JAT. Bowes & Church's Food Values of Portions
Commonly Used, 15th ed. Philadelphia: JB Lippincott Co.,
1989.
12. Holland B, Welch AA, Unwin ID, et al. McCance and Wid-
dowson's The Composition of Foods, 5th ed. London: Royal
Society of Chemistry, 1991.
13. Holland B, Unwin ID, Buss DH. Fruit and Nuts. The first
supplement to McCance & Widdowson's The Composition of
Foods, 5th ed. London: Royal Society of Chemistry, 1992.
14. Health & Welfare Canada. Nutrition Recommendations. The
Report of the Scientific Review Committee. Ottawa: Bureau of
Nutritional Sciences, Department of Health & Welfare, 1990.
15. Food and Nutrition Board. Recommended Daily Allowances,
10th ed. Washington, D.C.: National Academy Press, 1989.
16. National Research Council. Nutrient Adequacy. Assessment
Using Food Consumption Surveys. Subcommittee on Criteria
for Dietarv Evaluation, Co-ordinating Committee on Evalua-
tion of F~ood Consumption Surveys. Food and Nutrition
Board, Con'u'nission on Life Sciences. Washington, D.C.: Na-
tional Academy Press, 1986:25-40.
17. Snedcor GW, Cochran WG. Statistical Methods, 8th ed. Ames:
Iowa State University Press, 1989.
18. Health & Welfare Canada. Nutrition Canada Food Consump-
tion Patterns Report. Ottawa: Bureau of Nutritional Sciences,
Department of Health and Welfare, 1977.
19. Dwyer JT, Mayer LD, Kandel RF, et al. The new vegetarians.
Who are they? J Am Diet Assoc 1973;62:503.
20. Locong A. Nutritional status and dietary intake of a selected
sample of young adult vegetarians. J Can Diet Assoc 1986;47:
101.
21. National Center for Health Statistics. Dietary Intake Source
Data: United States, 1976-1980. Hyattsville, MD: National
Centre for Health Statistics, 1983; DHHS publication no. (PHS)
83-1681. (Series 11, no. 231).
22. Shultz TD, Leklem JE. Dietary status of Seventh Day Ad-
ventists and non-vegetarians. J Am Diet Assoc 1983;83:27.
23. Seoane NA, Roberge AG. Calorie and nutrient intakes of
adolescents in the Quebec City region. Can J Pub Health
1983;74:111.
24. Anderson GH, Peterson RD, Beaton GH. Estimating nutrient
deficiencies in a population from dietary records: The use of
probability analyses. Nutr Res 1982;2:409.
25. Gibson RS, Anderson BM, Sabry JH. The trace metal status of
a group of post-menopausal vegetarians. J Am Diet Assoc
1983;82:256.
300 DONOVAN AND GIBSON
26. Englyst HN, Bingham SA, Wiggins HS, et al. Nonstarch
polysaccharide consumption in four Scandinavian popula-
tions. Nutr Cancer 1982;4:50.
27. Bingham SA, Williams DRR, Cummings JH. Dietary fibre
consumption in Britain: new estimates and their relation to
large bowel cancer mortality. Br J Cancer 1985;52:399.
28. Sandler RB, Slemenda CW, Laporte RE, et al. Postmenopausal
bone density and milk consumption in childhood and adoles-
cence. Am J Clin Nutr 1985;42:270.
29. Guenther PM. Beverages in the diets of American teenagers. J
A m Diet Assoc 1986;86:493.
30. Linder MC. Nutrition and metabolism of the major minerals.
In: Linder, MC, ed. Nutritional Biochemistry and Metabolism.
New York: Elsevier Science Publishing Co., 1985:133-48.
31. Seoane NA, Roberge AG, Page M, et al. Selected indices of iron
status in adolescents. J Can Diet Assoc 1985;46:298.
32. Anderson BM, Gibson RS, Sabry JH. The iron and zinc status
of long-term vegetarian women. Am J Clin Nutr 1981;34:1042.
33. Monsen ER. Iron nutrition and absorption: dietary factors
which impact iron bioavailability. J Am Diet Assoc 1988;88:
786.
34. Helman AD, Darnton-Hill I. Vitamin and iron status in new
vegetarians. Am J Clin Nutr 1987;45:785.
35. Worthington-Roberts BS, Breskin MW, Monsen ER. Iron status
of pre-menopausal women in a university community and its
JOURNAL OF ADOLESCENT HEALTH Vol. 18, No. 4
relationship to habitual dietary sources of protein. Am J Clin
Nutr 1988;47:275.
36. Oberleas D, Harland BF. Phytate content of foods: Effects on
dietary zinc bioavailability. J Am Diet Assoc 1981;279:433.
37. Forbes RM, Parker HM, Erdman JW Jr. Effects of dietary
phytate, calcium and magnesium levels on zinc bioavailability
to rats. J Nutr 1984;114:1421.
38. Sandstrom B. Dietary pattern and zinc supply. In: Mills, CF,
ed. Zinc In H u m a n Biology. New York: Springer-Verlag,
1989;351-63.
39. Freeland-Graves JH, Bodzy PW, Eppright MA. Zinc status of
vegetarians. J A m Diet Assoc 1980;77:655.
40. Sloane BA, Gibbons CC, Hegstead M. Evaluation of zinc and
copper nutritional status and effects upon growth of southern
adolescent females. Am J Clin Nutr 1985;42:235.
41. Kinard JD, Lui Wu SM, Bazzarre TL. Zinc and copper status of
adolescent females. Nutr Res 1989;9:1207.
42. Srivasta US, Nadeau MH, Carbonneau N. Mineral intakes of
university students: cadmium and manganese content. Nutr
Rep Int 1978;18:325.
43. Millet P, Guilland ]C, Fuchs F, Klepping J. Nutrient intake and
vitamin status of healthy French vegetarians and nonvegetar-
ians. Am J Clin Nutr 1989;50:718.