The term vegetarian diet does not fully describe the variety in nutrient intakes and health status of those
Table 1 Common types of vegetarian dietary patterns categorized by animal food use
Lacto vegetarians Macrobiotics
Limit or avoid red meat and other flesh foods; may also restrict poultry, fish, and seafood. Diets are similar in most respects to nonvegetarian diets Avoidances include all meat, poultry, and often fish, but consume milk products and eggs. Iron may be limiting and it can be obtained from iron-fortified cereals. Low-fat dairy products are preferred to keep intakes of saturated fat and total fat moderate Avoid all meat, fish, poultry, and eggs. Nutrient considerations same as above
Numerous restrictions generally including avoidance of all meat, poultry, milk and eggs, but may consume fish in small amounts. Also avoid sugar and other refined sweeteners, foods that are members of the nightshade family (peppers, egg plant, tomatoes, and potatoes) and tropical fruits. Current variations of the diet are less restrictive than the versions of 30years ago, but deficiencies of energy, iron, calcium, vitamin B12, vitamin D, and other nutrients may still arise in weanlings, pregnant women, and young children if diets are nutritionally unplanned Avoidances include all animal products including meat, fish, poultry, eggs, and dairy products. Some vegans may also refuse to use any animal products in daily life. Without careful planning, energy, vitamins B12 and D, and bioavailable sources of iron may be low. Concentrated sources of energy-dense foods such as sugars and fats are helpful in increasing energy intakes. Vitamins B12 and D and calcium can be supplied from fortified soy milk, fortified cereals, and/or dietary supplements of these nutrients. Usually protein is adequate if a variety of protein sources is consumed Raw food eaters and 'living food' eaters avoid animal foods and eat raw plant foods, including fruits, vegetables and cereals with special health foods such as wheatgrass or carrot juice. Fruitarians consume diets mostly of fruits, nuts, honey, and olive oil. Rastafarians eat a near-vegan diet and avoid alcohol, salt-preserved foods and additives. Yogic groups vary in their eating patterns but are often lacto vegetarian who follow such eating patterns. There are many different types of vegetarian eating patterns (see Table 1). The impact of these patterns on nutritional status and health requires more complete characterization of diet and other aspects of lifestyle than such a simple descriptor.
The terms vegetarian, lactovegetarian, and vegan focus on foods that are left after others have been omitted from the diet. From the nutritional standpoint the animal food groups (e.g., meat fish, fowl, eggs, milk, and milk products) are nutrient-dense foods. In traditional diets of usual foods, they were often rich sources of certain nutrients. Depending on the particular animal food group under consideration, these nutrients may include protein of high biological value, highly bioavailable iron, zinc, calcium, vitamins A, D, B12 and B6, riboflavin, omega 3 fatty acids, and iodine. When these food groups are eliminated entirely from the diet, intakes of the nutrients these groups are rich in may fall short.
Although dietary diversity in the number of food groups consumed is less among vegetarians, diversity within food groups is often considerable and is sufficient to provide adequate amounts of nutrients. Variety within food groups may even be increased on vegetarian diets. For example, among those consuming vegan diets the amount and type of legumes as well as other vegetables and fruits is often increased.
Eating patterns appear to be more closely associated with health outcomes than are nutrient intakes alone. Therefore, it is important to also consider other phytochemicals and zoochemicals in vegetarian diets that may have health effects.
Vegetarians' intakes of some of the bioactive constituents that are rich in fruits and vegetables such as the flavonoids, antioxidants, and dietary fiber may be much higher than those of omnivores. If these substances prove to have beneficial effects on health, such increased intakes may be important.
From the nutritional standpoint there are beneficial trade-offs from vegetarians' limited animal food intakes. Animal foods are major sources of dietary constituents that are in excess in Western diets, such as high amounts of calories, fat, saturated fat, cholesterol, and low amounts of dietary fiber. Consumption of fewer animal foods, especially if it leads to lesser intakes of these constituents may have positive effects on overall nutritional status. Thus, there are both nutritional benefits and risks to limiting animal foods. The exact effects on nutritional status will vary depending on the food group avoided, the degree of limitation, substitutions of other rich food sources, use of fortified foods and dietary supplements, and other changes in dietary intake that occur at the same time. The nutritional goal is to maximize the benefits and minimize the risks by a judicious choice of the type and amount of animal foods or other sources of the nutrients they contain.
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