Though eating a vegetarian diet does not affect growth and nutrition in children, they can be at higher odds of being underweight, according to a study of nearly 9,000 kids in Canada

The finding comes amidst the growing popularity of plant-based diets and a changing food environment with more access to plant-based alternatives.

Researchers at St. Michael’s Hospital of Unity Health in Toronto examined children aged six months to eight years and found that children who had a vegetarian diet had similar mean body mass index (BMI), height, iron, vitamin D, and cholesterol levels compared to those who consumed meat.

At the same time, compared to those who eat meat, these kids had almost two-fold higher odds of having underweight, defined as below the third percentile for Body Mass Index. There was, however, no evidence of an association with overweight or obesity, revealed the study, published in Pediatrics journal.

Underweight is an indicator of undernutrition and may be a sign that the quality of the child’s diet is not meeting the child’s nutritional needs to support normal growth. The researchers emphasized the need for special care when planning the diets of vegetarian kids.

“This study demonstrates that children following vegetarian diets had similar growth and biochemical measures of nutrition compared to children consuming non-vegetarian diets. The vegetarian diet was associated with higher odds of underweight weight status, underscoring the need for careful dietary planning for children with underweight when considering vegetarian diets,” said lead author Jonathon Maguire, a pediatrician at the hospital.

International guidelines about vegetarian diet in infancy and childhood have differing recommendations, and past studies that have evaluated the relationship between vegetarian diet and childhood growth and nutritional status have had conflicting findings.

“Plant-based dietary patterns are recognized as a healthy eating pattern due to increased intake of fruits, vegetables, fiber, whole grains, and reduced saturated fat; however, few studies have evaluated the impact of vegetarian diets on childhood growth and nutritional status. Vegetarian diets appear to be appropriate for most children,” Maguire said.

The team also acknowledged limitations of the study such as they did not assess the quality of the vegetarian diets and stressed the need for further studies.