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PROTEIN RECOMMENDATIONS FOR VEGETARIANS AND VEGANS:
AN INTEGRATIVE REVIEW
Bárbara Caldeira1
Pâmela Antoniazzi dos Santos2
Abstract: Objective: Analyze ocial protein recommendations for vegan and vegetarian individuals
in all life stages. Methods: Integrative review carried out with ocial recommendations from six
dierent countries and one continent, found in the PubMed database e Google Scholar. This study
included articles with ocial recommendations from dierent countries, published in the last ten years
in English, Spanish or Portuguese. Results: In the search, after analyzing the titles and abstracts, seven
articles were considered for the study. Conclusions: Considering only proteins, it is possible to have a
healthy vegetarian diet, provided that individuals are careful with protein consumption so that the daily
recommendations are met and there is not any deciency related to this macronutrient. However, in
vegan diets, individuals should have greater caution since these only include plant protein sources which
have lower bioavailability and, therefore, need to be consumed in a bigger quantity and from various
dierent sources throughout the day. Nutritional assistance is essential in this dietary choice.
Keywords: Diet, vegetarian. Plant protein. Life cycle stages.
1 Academic of the Nutrition Course, University of Caxias do Sul
2 Advisor, Nutritionist, Master in Health Sciences- Maternal Child Health, Teacher of the Nu-
trition Course, University of Caxias do Sul
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INTRODUCTION
Interest in the term vegetarianism and what it means has been growing in recent years. In 2018
in Brazil, around 14% of the country’s population called themselves vegetarian, 55% of participants
stated that they would buy more vegan products if specied on the packaging and 60% would be
interested in this dietary pattern if the products were more nancially accessible (Ibope, 2018).
Vegetarianism is characterized by the exclusion of meat of all types, with some subdivisions
within it depending on the type of food excluded from the diet. While some individuals exclude
only meat from their diet (ovolactovegetarians, lactovegetarians or ovovegetarians ), others remove
all foods of animal origin, such as eggs, dairy products and honey (strict vegetarians and vegans).
Therefore, the basis of vegetarian diets are cereals, legumes, fruits and vegetables, with no or varying
amounts of eggs, milk and dairy products (Satija and Hu, 2018; Sakkas et al. , 2020).
The reasons why individuals choose to follow a vegetarian diet are diverse, among the main
reasons are animal rights, health and well-being, ethics, the environment and religious/spiritual
reasons (Carvalho and Moreira, 2020).
Proteins are fundamental for the functioning of the human body, therefore there are daily
recommended values that must be achieved (Rosa et al ., 2021). According to the IOM ( Institute of
Medicine ) the acceptable range of protein distribution is 10-35% of the total energy value ( National
Academies of Sciences , Engineering , and Medicine , 2019 ).
Although scarce, recent studies indicate that protein intake in vegetarians is within the
appropriate distribution, although consumption is lower than in omnivores ( Neungerl and Eilander
, 2021).
The objective of this integrative review was to analyze protein nutritional recommendations
from dierent countries for vegetarians and vegans at all stages of life.
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METHODS
This is an integrative review of the literature (Souza et al. , 2010). The PubMed and Google
Scholar databases were used for the searches . The following phrases were used for the search: “ Position
paper on vegetarian guidelines ” , “European consensus on vegetarianism” and “Brazilian consensus
on vegetarianism”. The inclusion criteria were: articles that comprised ocial recommendations from
dierent countries, articles published in English, Spanish or Portuguese and published in the last ten
years.
The selection of studies was carried out between April and May 2024. The analysis of the
articles was carried out descriptively in a Google spreadsheet, considering the inclusion criteria
and the following characteristics of each article: identication of the article, audience involved,
recommendation of proteins and conduct description.
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Papers search
Pubmed and Google Scholar
Period
April and May 2024
Search phrases
"European consensus on vegetarianism"
"Brazilian consensus on vegetarianism"
Papers Selection - Step 1
The two reviewers independently
analyzed the titles and abstracts
of the articles.
Papers Selection - Step 2
The two reviewers independently
evaluated the papers in full and
selected the articles for the study.
Selected data
They were extracted from a Google spreadsheet.
RESULTS
From the searches carried out in the databases and after reading the article summaries and
applying the inclusion criteria, seven articles were selected to be part of this study.
Recommendations from six dierent countries and one continent were analyzed, namely:
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Germany, Brazil, United States of America, Spain, Italy, Portugal and Europe. These articles comprise
recommendations from medical and/or nutrition associations regarding vegetarian or vegan diets for
dierent stages of life. Two of these recommendations were published in 2016, one in 2017, one in
2018, one in 2019, one in 2021 and another in 2022. Of these recommendations, only the macronutrient
protein was considered for the analysis.
Location/ Year/
Identication
Life stage Recommendations
Italy / 2017 /
Italian Society of
Human Nutrition
All stages of life Pregnant and breastfeeding women : breast milk from vegetarian breastfeeding women
is nutritionally adequate; babies who receive milk from well-nourished vegetarian
breastfeeding women grow normally.
Preschoolers ( 6 months to 3 years) : children who follow a suitable vegetarian diet have
similar growth to non-vegetarian children.
Children (4-10 years) : Vegetarian children’s protein intake meets recommendations,
although they still consume less protein than omnivorous children. Since plant-based
proteins are less digestible and contain fewer essential amino acids, it is recommended
that vegan children consume more protein sources. One study suggests 30-35% of VET
in children under 2 years old and 20-30% in 2-6 year olds.
Adolescents (11 – 18 years) : Studies show that there is not much dierence in growth
in vegetarians and omnivores. Just like children, vegan teenagers may need greater
amounts of protein than omnivores and vegetarians. One study recommends that active
vegans consume 7-10% of VET and sedentary people 10-13%.
Adults : protein consumption in vegetarian and vegan adults is, in general, lower than
in omnivores, but meets recommendations. One study suggested increasing the protein
recommendation for women from 0.8 to 1.0 g/kg/day, as the women in this study
consumed more plant-based protein than animal protein.
Elderly people : they have lower protein intake compared to omnivores, however, in
most cases, they reach the recommendation.
Spain / 2019/
Committee on
Nutrition and
Breastfeeding of the
Spanish Pediatric
Association]
Children and
teenagers
Achieve daily protein and energy recommendations.
It is recommended to consume dierent foods rich in vegetable protein (such as
legumes, seeds and nuts) daily. Other foods that help to achieve adequate consumption
are soy and derivatives and pseudocereals such as quinoa and amaranth. Care is needed
in periods of life where needs are increased.
Europe/ 2021/
European Society
for Pediatric
Gastroenterology,
Hepatology and
Nutrition Committee
on Nutrition
Children and
teenagers
Inadequate consumption of calories, proteins and other nutrients can occur in vegetarian
diets due to the limited variety of choices. Therefore, it is recommended that a child
following a vegetarian diet have adequate nutritional planning and monitoring by a
trained health professional.
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Germany / 2016/
German Nutrition
Society (DGE)
All stages of life An adequate distribution of dierent protein sources throughout the day is recommended,
as well as adequate energy consumption. By combining dierent vegetable proteins, the
quality of consumption will increase, as well as the intake of all essential amino acids.
Children: During the growth phase, children need more amino acids than adults,
therefore it is essential to ensure adequate protein and energy intake.
United States/
2016/ Academy
of Nutrition and
Dietetics
All stages of life A varied consumption of plant foods daily provides sucient essential amino acids if
the energy value meets the recommendations. Regular consumption of legumes, soy
and derivatives is recommended to ensure adequate protein intake, as well as providing
other nutrients.
Children and adolescents: vegans in this age group may have slightly higher protein
needs than non-vegan children due to the lower digestibility of the amino acid
composition. A protein intake of 30-35% has been suggested for children 1 to 2 years
of age, 20 to 30% for 2 to 6 years, and 15 to 20% for 6 years and older.
Elderly: Some evidence suggests that with aging, protein is used less eciently by the
body, which suggests greater needs for this nutrient. It is necessary for older vegetarians
and vegans to include protein-rich foods (such as legumes and soybeans) in their diets.
Portugal/ 2018/
Portuguese Nutrition
Association
Children in the rst
years of life
6 months : Exclusive breastfeeding. Breast milk from a well-nourished nursing
mother (if vegetarian ensures adequate nutritional intake through food or nutrient
supplementation), meets all the baby’s nutritional needs.
5th and 6th month: Period of dietary diversication, in the European context this period
can begin between the 5th and 6th month of life. From that moment on, it is necessary to
progressively replace the protein that previously came from breast milk or exclusively
use formula. You can start to introduce another protein of vegetable origin such as tofu
(fresh and without seasoning), legumes (soaked to facilitate digestion) and, if you are a
lacto-ovo vegetarian, eggs (from 8 months yolk and 9 months white).
8 months: From 8 months onwards, hemp protein can be oered, which has 46g of
protein for every 100g of food. Due to the large amount of protein, if oered, it should
be in small quantities, maximum of one spoonful of coee/meal at 8 months and one
spoonful of dessert/meal at 9 months). Another option is pea protein, with which care
must be taken regarding the high sodium content, therefore it must be used with caution
in the 1st year of life. Foods such as natural yogurt, fermented soy preparation (vegan),
seaweed, tempeh (fermented soy), seitan (wheat gluten) can also be gradually included
in the vegetarian or vegan infant’s diet.
12 months : It is recommended to continue breastfeeding until 12 months, associated
with the appropriate consumption of other foods with progression of textures. If it is
not possible to continue breastfeeding, infant formula can be used; for healthy infants,
vegan formulas available on the market, such as soy or rice, can be used.
From 12 months onwards, integration into the family diet should occur. Vegetable
drinks such as soy, almond and oat drinks do not replace formulas and should not be
introduced before 24 months, as they do not provide sucient nutrients.
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Brazil/ 2022/
International Life
Sciences Institute
Children up to 5
years of age
In vegan diets, sources of protein are beans, grains, nuts, seeds and green leafy
vegetables. 20 amino acids are found in these foods, including the 9 essential ones.
Other foods that have a similar amount of amino acids to animal protein are soy and
derivatives, pseudocereals (wheat, buckwheat, quinoa and amaranth), lupins, spinach
and hemp seeds. In vegan diets, the amino acid lysine is present in smaller quantities,
due to low amounts present in food sources (grains), most of the time not reaching
recommendations, as well as methionine and cysteine present in legumes.
Vegetable proteins have lower digestibility than those from animals, around 10 to 30%
less. In the rst years of life, protein needs vary from 1.2 to 2.2 g/kg/day, and in younger
infants the recommendation is higher. According to the RDA (Recommended Dietary
Intake), children under 2 years old should be oered 20% more protein, and children
aged 2 to 6 years old should be oered 10 to 15%, with these proteins coming from
dierent sources. In older children, the need is lower, so only a few adjustments are
necessary, being around 10 to 15% more of the daily amount of protein.
Vegetable-based drinks do not have the same nutrients as cow’s milk and its derivatives,
so it is necessary to be aware of the risk of malnutrition and micronutrient deciency.
Vegetable-based infant formulas are enriched with methionine and other micronutrients
due to regulatory legislation. Vegetable proteins such as tofu, tempeh (fermented
soybeans) and seitan (processed gluten/wheat extract) do not have the same protein
quality as proteins from animal sources, nor the supply of micronutrients found in them.
Table 1. Results
DISCUSSION
Pregnant and breastfeeding women
Protein nutritional needs are increased during pregnancy due to fetal growth, the increase
in fetal annexes and the accelerated expansion of blood volume. An adequate diet reduces the risk of
fetal death and improves fetal growth . At this stage of life, nutritional recommendations are generally
increased, with 1.1 to 1.2 g/kg/day (or at least 71g/day) being recommended. During the second and
third trimesters , there is a need for 21g/day for fetal tissues and placenta alone (Sebastiani et al. ,
2019).
Due to the increase in protein needs in the last two trimesters and during breastfeeding,
additional portions of protein-rich foods such as beans, lentils, chickpeas, soybeans and their
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derivatives should be included. In the case of lacto-ovo vegetarians, eggs and dairy products can also
be included (Baroni et al. , 2018).
In a cohort study carried out with vegetarian and vegan pregnant women in the United States,
it was found that they consumed less protein/day than non-vegetarians, 56.2g/day and 91.3g/day,
respectively. The study suggests that newborns born to vegetarian women are smaller than average
in height, but still within the normal range. No relationship was found between vegetarianism and
gestational diseases or postpartum mortality ( Yisahak et al. , 2020).
pre -pregnancy weight , should monitor their protein intake more carefully. This study
also associated the low weight of newborns with vegan mothers, one explanation for this was the
low weight of the woman before pregnancy, as vegan women are more susceptible to low weight (
Kesary et al., 2020). Another study published in 2023 states that vegan women with compromised
prenatal nutritional status may have low fat reserves for breastfeeding. Therefore, these women must
be monitored closely and carefully to ensure adequate consumption of all nutrients, vitamins and
necessary supplementation, thus reducing the risk of health problems. (Bali and Naik , 2023)
The Italian Society of Human Nutrition states that breast milk from vegetarian breastfeeding
women, as long as they are well nourished, is nutritionally adequate for the baby. ( Agnoli et al .,
2017). A study from Norway also stated that as long as the nursing mother is consuming and/or
supplementing her diet adequately, the baby only needs breast milk, only if necessary including the
use of infant formula (Hay et al. , 2022).
Children and teenagers
At these stages of life, protein is essential for growth, and adequate consumption is essential
within the needs of each stage. This macronutrient also participates in the restoration and construction
of tissues, among other functions ( Savarino al. , 2021).
The general recommendation, for children up to one year of age, is 1.2g/kg/day. From the
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rst year of life to 3 years of age, the recommendation is 1.05 g/kg/day and from 4 to 13 years of age,
0.95 g/kg/day is recommended. The recommended values for adolescents aged 14 to 18 are 0.85g/
kg/day for both sexes. The values do not dierentiate between omnivores and vegetarians ( National
Academies of Sciences , Engineering , and Medicine, 2019).
Until six months of age, exclusive breastfeeding is recommended, as the breast milk of a
well-nourished vegetarian breastfeeding woman is enough to meet all the baby’s nutritional needs. (
Agnoli et al ., 2017; Pimentel et al. , 2018)
Studies state that the quality of vegetable protein is lower when compared to animal protein,
its digestibility is lower, therefore, for both children and adolescents, it is necessary to consume
dierent sources of protein throughout the day so that the recommendations are achieved ( Agnoli
et al ., 2017; Ferreiro et al. , 2020; Melina et al ., 2016; Konstantyner et al ., 2022). Due to the lower
bioavailability of protein in foods of plant origin, it is recommended to increase the amount of protein/
day, the amounts vary depending on age. It is estimated that the digestibility of vegetable proteins
is around 10 to 30% lower than that of animal proteins ( Konstantyner et al ., 2022). The Academy
Nutrition and Dietetics suggests an intake of 30-35% for children 1 to 2 years of age, 20 to 30% for 2
to 6 years, and 15 to 20% for 6 years and older ( Melina et al ., 2016). Recommendations in Italy use
the same percentages for children and add that active vegan teenagers should consume 7-10% of VET
and sedentary teenagers 10-13% ( Agnoli et al ., 2017). The ILSI Brasil Consensus reports slightly
dierent numbers, the recommendation is that children under 2 years old should be oered 20% more
protein, and children aged 2 to 6 years old should be oered 10 to 15%, maintaining this last guideline
as well. for older children ( Konstantyner et al ., 2022).
According to the Italian Society of Human Nutrition , protein consumption in children aged
four to ten years old reaches the daily recommendations, although consumption is lower than that of
omnivorous children ( Agnoli et al ., 2017).
Some studies indicate that inadequate consumption of proteins and other nutrients can occur
in vegetarian diets due to a limited variety of choices. Therefore, if the child/adolescent follows a
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vegetarian diet, adequate nutritional planning is recommended, especially in periods of life where
needs are increased. and follow-up with a trained healthcare professional ( Verduci et al. , 2021;
Ferreiro et al. , 2020).
Adults
During adulthood, the recommendation is the same for both sexes, being 0.8 g/kg/day (
National Academies of Sciences , Engineering , and Medicine , 2019).
Some studies propose that protein consumption in vegetarian and vegan adults, although
lower than that of omnivores, reaches or even exceeds the daily protein intake recommendation, as long
as caloric intake is adequate ( Melina et al ., 2016; Agnoli et al ., 2017; Richter et al. , 2016 ). A review
study compared protein consumption data among vegan, vegetarian and omnivorous adults, without
considering the use or not of supplements. The results showed that vegans and vegetarians consume
less protein when compared to carnivores, being 12.9%, 13.4% and 16% respectively . According
to the results, although consumption is lower, it is still within the macronutrient distribution values
established by Acceptable Macronutrient Distribution Range (AMDR), which is 10 to 35% of the
total energy value/day ( Neungerl et al. , 2021; National Academies of Sciences , Engineering , and
Medicine , 2019).
Another review study calculated and compared the amount of protein consumed by omnivores,
vegetarians and vegans, according to the amounts presented in two dierent studies, one carried out
in France and the other in England. Although the studies were conducted in dierent locations, with
dierent populations, number of participants and eating habits, the results found were very similar to
each other and to the previously mentioned study. The French study found that omnivores would be
consuming an average of 84 grams of protein/day, being around 17.6% of the total energy value/day,
vegetarians would be consuming 64g/day, being 14.2% and vegans 60g/day , being 12.8%. The British
study found 90g/day, 70g/day and 64g/day, being 17.2%, 14% and 13.1%, respectively for omnivores,
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vegetarians and vegans. Again, although the values vary between people who consume meat and
those who do not, the values found are within those recommended by the DRIs - “ Dietary Reference
Intakes for Sodium and Potassium ” (Mariotti and Gardner, 2019; National Academies of Sciences ,
Engineering , and Medicine, 2019).
Elderly
Elderly people have an increased need for protein for general health, this macronutrient helps
to improve illnesses and maintain the proper functioning of the body. Attention should also be paid
to adequate consumption to reduce muscle loss that occurs naturally with age ( Baum et al , 2016).
In old age, the DRIs recommendation for protein consumption remains the same as in adult
life of 0.8g/kg/day ( National Academies of Sciences , Engineering , and Medicine , 2019). A 2014
study based on a workshop presented by the European Society for Clinical Nutrition and Metabolism
(ESPEN), suggests dierent values due to the increased needs of this age group. This recommendation
proposes that healthy elderly people should ingest 1.0 to 1.2 grams of protein/kg of weight/day and
for elderly people with chronic or acute diseases, 1.2 to 1.5 g of protein/kg/day, in the case of serious
illnesses or injuries this consumption must be even greater ( Deutz et al. , 2014).
The Academy of Nutrition and Dietetics states that as we age, protein is used less eectively
by the body, which may mean a greater need for this macronutrient. Therefore, older vegetarians and
vegans should include protein-rich foods (such as legumes and soybeans) in their diets daily. Another
study adds that these foods should be consumed two to three times a day ( Melina et al ., 2016; Craig
et al. , 2021) . A third study also suggests the consumption of 0.4g/kg/meal to prevent the loss of
muscle mass in the elderly, or around 30g/meal of more digestible protein (such as soy, for example)
to improve protein synthesis. , this study considered elderly people in general, without dierentiating
diets (Lancha et al ., 2016). The recommendation from Italy states that there are few studies available
on elderly vegetarians, but the evidence indicates that, although elderly people have lower protein
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intake than omnivores, they are still within the appropriate range ( Agnoli et al ., 2017).
CONCLUSION
Of the recommendations analyzed, three of them ensure that well-planned vegetarian diets
provide all the nutrients necessary for the cycles of life ( Agnoli et al ., 2017; Melina et al ., 2016;
Pimentel et al. , 2018). Two of them reinforce that vegetable proteins have lower bioavailability than
animal proteins, therefore, vegetarians should consume more protein than recommended for the
general population ( Agnoli et al ., 2017; Melina et al ., 2016 ).
Three other recommendations, two focusing on infants and children and another on all
life cycles, do not recommend strict vegetarian or vegan diets due to the greater risk of nutritional
deciencies. Mainly during periods of greatest energy need, such as pregnancy, breastfeeding,
childhood and adolescence . Omnivorous diets are recommended, with a large intake of plant foods or
ovolactovegetarian diets, as in the long term they are safer and guarantee adequate nutritional intake
( Ferreiro et al. , 2020 ; Konstantyner et al ., 2022 ; Richter et al. , 2016).
Three of them also reiterate the importance of adequate nutritional monitoring, with
professionals trained in counseling and health promotion ( Konstantyner et al ., 2022 ; Verduci et al.
, 2021; Pimentel et al. , 2018).
It is concluded that monitoring with a professional nutritionist is essential to assess the patient’s
health prole, nutritional status, life cycle and food preferences, in order to dene a personalized
approach for each individual. Furthermore, the importance of including protein-rich foods in the main
meals is highlighted to achieve the daily recommendation for this macronutrient in each age group.
Limitations: The study has limitations inherent to a literature review. Therefore, more studies
are suggested with vegetarians and vegans in all life cycles, to reach more precise conclusions, given
the scarcity of studies and ocial recommendations related to this topic.
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