Dietary intake and nutritional status of young vegans and
omnivores in Sweden1–3
Christel L Larsson and Gunnar K Johansson
ABSTRACT
Background: Adolescents sometimes become vegetarian for
ethical rather than health reasons. This may result in health prob-
lems caused by lack of interest in and knowledge of nutrition.
Objective: We compared the dietary intake and nutritional status
of young Swedish vegans and omnivores.
Design: The dietary intakes of 30 vegans (15 males and 15 females;
mean age: 17.5 ± 1.0 y) and 30 sex-, age-, and height-matched
omnivores were assessed with the use of a diet-history interview
and validated by the doubly labeled water method and by meas-
uring nitrogen, sodium, and potassium excretion in urine. Iron
status and serum vitamin B-12 and folate concentrations were
measured in blood samples.
Results: The diet-history method underestimated energy intake
by 13% and potassium intake by 7% compared with the doubly
labeled water method and 24-h urine excretion, respectively.
Reported dietary nitrogen and sodium intakes agreed with the
24-h urinary excretion measure. Vegans had higher intakes of
vegetables, legumes, and dietary supplements and lower intakes
of cake and cookies and candy and chocolate than did omnivores.
Vegans had dietary intakes lower than the average requirements
of riboflavin, vitamin B-12, vitamin D, calcium, and selenium.
Intakes of calcium and selenium remained low even with the
inclusion of dietary supplements. There was no significant dif-
ference in the prevalence of low iron status among vegans (20%)
and omnivores (23%). Two vegans with low intakes of vitamin B-12
had low serum concentrations.
Conclusion: The dietary habits of the vegans varied consider-
ably and did not comply with the average requirements for some
essential nutrients. Am J Clin Nutr 2002;76:100–6.
KEY WORDS Adolescents, diet-history method, dietary
intake, folate, iron, nutritional status, vegan, vegetarian, omnivore,
vitamin B-12, Sweden
INTRODUCTION
In the early 20th century, few people accepted vegetarian
foods as sufficient for a healthy diet, although many realized that
eating more vegetables was necessary for good health (1). In the
middle of the 20th century, a Scandinavian author, Are Waerland
(2), strongly emphasized the importance of a lactovegetarian
diet, physical activity, and abstinence from alcohol and tobacco
in restoring good health to the body. Waerland advocated a diet
100 Am J Clin Nutr 2002;76:100–6. Printed in USA. © 2002 American Society for Clinical Nutrition
characterized by high intakes of water, vegetables, fruit, and
berries; limited intakes of dairy products, salt, and spices; and
the exclusion of meat, fish, eggs, coffee, tea, sugar, white flour,
alcohol, and tobacco (2). This diet and lifestyle were endorsed to
promote health and to avoid and cure diseases. Ethical concerns
were not a major issue.
A well-planned and varied vegetarian diet is perfectly consis-
tent with good health and can potentially reduce the risk of many
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chronic diseases (3). However, care must be taken during times of
extra nutritional demand, such as adolescence, to ensure sufficient
intake of energy, calcium, iron, and vitamins B-12 and D (4).
Approximately 5% of Swedish students aged 16–20 y eat a veg-
etarian school lunch, and 0.1% eat vegan food (5). Consumption
of vegan school lunches is more common in some areas of Swe-
den than in others. For example, in the northern town Umeå, 2%
of 16–20-y-olds were reported to eat a vegan school lunch (5).
Vegetarianism may be a fad with some adolescents, but for oth-
ers it is based on a strong conviction that lasts for years or even
a lifetime. Young people choose to adhere to a vegetarian diet for
many reasons, but ethical and ecologic concerns appear to be a
more common motivation than health (6). Consequently, some
young vegetarians may have limited nutritional interest and
knowledge and poor meal planning. There is a risk that meat and
other animal products are excluded without being replaced by
nutritionally equivalent vegetarian foods. In these cases, the
overall dietary intake may not comply with the daily nutritional
needs of the adolescents. The concern increases with more
restrictive food choices and would most likely be greater for veg-
ans than for other types of vegetarians.
The aim of this study was to assess the dietary intake and
nutritional status of a group of Swedish vegans aged 16–20 y liv-
ing in Umeå, Sweden, by using a validated diet-history (DH)
1
From the Department of Food and Nutrition, Umeå University, Umeå,
Sweden.
2
Supported by grants from the Faculty of Social Sciences, Umeå Univer-
sity; the Swedish Institute; the Swedish Foundation for Healthcare Science
and Allergy Research; the Swedish Nutrition Foundation; and the JC Kempes
Memorial Fund.
3
Address reprint requests to CL Larsson, Department of Food and Nutri-
tion, Umeå University, SE-901 87 Umeå, Sweden. E-mail: christel.larsson@
kost.umu.se.
Received February 5, 2001.
Accepted for publication July 11, 2001.
 DIET AND NUTRITIONAL STATUS OF ADOLESCENTS
method and blood samples to compare the results with those for
sex-, age-, and height-matched omnivores.
SUBJECTS AND METHODS
Subjects
Volunteers were recruited through advertising and visits to
schools in the Umeå area. The subjects had to be 16–20 y of age
and in good health, with no chronic diseases. Vegans were
defined as people eating food of plant origin only and were
included in the study if they had consumed a vegan diet for ≥ 6
mo and were planning to continue. Omnivores were defined as
people eating food of both plant and animal origin and were
included if they had consumed an omnivorous diet for their
entire life and were planning to continue this diet. In total, 65
vegetarians and 272 omnivores were interviewed. Thirty vegans
were eligible for inclusion. Thereafter, 30 omnivores were
matched by sex, age (± 6 mo), and height (± 3.5 cm). Each par-
ticipant gave written, informed consent, and the study was
approved by the Research Ethics Committee of the Medical Fac-
ulty, Umeå University, Umeå, Sweden.
Dietary assessment
Each respondent was asked about customary food intake
during 2 separate 1–2-h DH interviews (1–2 wk apart) during
August 1997–June 1998. The aim was to construct a typical
eating pattern for the preceding 3 mo. Portion sizes of foods
were described in terms of household measures, standard
weights of food items, 3-dimensional food models, or portion
photographs of known weights (7). The reported food, bever-
age, and dietary supplement intakes were entered in the dietary
analysis program Stor MATs 4_03e (Rudans Lättdata, Västerå,
Sweden), which uses the Swedish food composition database
(version 2_97; National Food Administration, Uppsala, Swe-
den). Recipes and information on nutritional content were
entered for composite foods and dietary supplements not listed
in the food database. The calculated vitamin and mineral
intakes were compared with average requirements for groups
and lowest recommended intakes for individuals, according to
the Nordic Nutrition Recommendations (8). Body weight was
measured with a scale to the nearest 0.1 kg while the subjects
were wearing light underwear, and height was measured to the
nearest 0.5 cm.
Validity of the dietary assessment
Energy expenditure determined by the doubly labeled water
(DLW) method and measurement of nitrogen, sodium, and potas-
sium excretion in 24-h urine collections were used to validate
reported energy and nutrient intakes (9). The total energy expen-
diture of 32 subjects (16 vegans and 16 matched omnivores) was
measured during 14 d with the use of the DLW method (10). To
validate reported nutrient intakes, nitrogen, sodium, and potas-
sium excretion was measured in all subjects by using four 24-h
urine collections per person (11). Sodium and potassium in urine
were determined by flame atomic absorption spectrophotometry
(Perkin-Elmer model 5000; Norwalk, CT), according to routine
clinical laboratory procedures, and urine collections with para-
aminobenzoic acid recovery between 50% and 85% were
adjusted by a linear regression method (12). We previously
described the validity of the DH (13).
101
The reported intakes of energy, nitrogen, sodium, and potas-
sium were divided by the respective biological markers to detect
under- or overestimation in the DH (10). Measured energy
expenditure, nitrogen in urine divided by the excretion factor
0.81 (11), and sodium in urine (14–16) were used as biological
markers for reported energy, nitrogen, and sodium intakes,
respectively. The measured potassium in urine divided by the
excretion factor—0.73 for lactovegetarians and 0.77 for omni-
vores (15)—was used as the biological marker for potassium
intake, because potassium in feces was not measured (14).
Nutritional assessments
After the DH interviews, 3 fasting venous blood samples (1 wk
apart) were taken. Hemoglobin, serum iron and ferritin, total-
iron-binding capacity, transferrin saturation, and immune cell
concentrations were measured to enable classification of the sub-
jects’ iron status. Three blood samples were required to accu-
rately determine ferritin (17). Before each blood sample was taken,
the subjects completed a short questionnaire about the last time
they had eaten, infections, antibiotic treatment, dieting, and stress.
One fasting venous blood sample for measuring vitamin B-12
and folate in serum was taken at the same time as the first sam-
ple for iron-status classification.
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All blood samples were analyzed according to standard meth-
ods used at the Clinical Chemistry Department, University Hos-
pital of Umeå, Umeå, Sweden. Hemoglobin was measured by
using cyanmethemoglobin and an absorbance measurement on a
sample in EDTA-containing tubes. Iron was measured by a col-
orimetric assay, ferritin by an immunoturbidimetric assay, and
total-iron-binding capacity by an alkaline buffer–reductant solu-
tion from Roche Diagnostics (Indianapolis). Iron status was clas-
sified as normal, early negative iron balance, iron depletion,
iron-deficient erythropoiesis, or iron deficiency anemia, accord-
ing to definitions by Herbert (18). Vitamin B-12 and folate were
analyzed with the Quantaphase II B12/Folate Radioassay (Bio-
Rad Scandinavia Inc, Upplands Väsby, Sweden). Adequate blood
concentrations of vitamin B-12 and folate were defined as within
95–568 pmol/L and 3.4–47 nmol/L, respectively.
Statistical analyses
Data are expressed as means ± SDs and means with 95% CIs.
Differences between measurements and groups were analyzed
with the use of the Mann-Whitney U test. A two-tailed P value
of < 0.05 was considered statistically significant. All statistical
analyses were performed with SPSS (version 10.0; SPSS, Inc,
Chicago).
RESULTS
Subjects
The present paper reports dietary data on 60 age-, sex-, and
height-matched adolescents with a mean age of 17.5 ± 1.0 y, living
in Umeå, Sweden. Male vegans weighed less than male omnivores
(70.9 ± 5.0 and 65.9 ± 7.0 kg, respectively) and had a lower body
mass index [BMI (in kg/m2); 22.0 ± 1.3 and 20.5 ± 2.1, respec-
tively], P < 0.01. There was no significant difference in body
weight and BMI between female omnivores (weight: 60.1 ± 8.8 kg;
BMI: 21.1 ± 2.7) and female vegans (weight: 65.6 ± 10.6 kg; BMI:
23.1 ± 4.0). The vegans had been consuming a vegan diet for a
mean of 1.7 y (range: 0.5–3.5 y) and a vegetarian diet for 2.8 y
102 LARSSON AND JOHANSSON
TABLE 1
Validation of reported intakes of energy, nitrogen, sodium, and potassium in 30 vegans and 29 omnivores with the use of the doubly labeled water method
and 24-h urine collections1
Females
Vegans (n = 15)
2
EIrep/EEmea 0.84 ± 0.25
(Nrep  0.81)/Nmea3 1.00 ± 0.32
Narep/Namea4 0.78 ± 0.425
(Krep  0.73 or 0.77)/Kmea6 0.90 ± 0.30
1–
x ± SD. EI, energy intake; rep, reported; EE, energy expenditure; mea, measured; N, nitrogen. The Mann-Whitney U test was used for statistical com-
parisons between groups with different diets.
2
Reported energy intake of 32 subjects (16 vegans and 16 omnivores; 44% female) divided by energy expenditure, as measured by the doubly labeled
water method (13).
3
Reported nitrogen intake times the urinary excretion factor of nitrogen, 0.81 (11), divided by measured nitrogen in urine.
4
Reported sodium intake divided by measured sodium in urine.
5
Significantly different from female omnivores (P < 0.05).
6
Reported potassium intake times the urinary excretion factor of potassium, 0.73 for vegans and 0.77 for omnivores (15), divided by measured potas-
sium in urine.
(range: 0.7–4.0 y). All 30 vegans reported ethical reasons as
their primary motivation for being vegan; 4 also mentioned
health reasons.
Validity of the dietary assessment
There was no significant difference in the validity of reported
energy, nitrogen, or potassium intakes between the dietary groups
(Table 1). However, the validity of reported sodium intake was
significantly lower for female vegans than for female omnivores
(P < 0.05). The DH method underestimated energy intake by
1.93 MJ/d (95% CI: 2.89, 0.97 MJ/d) compared with the
DLW method. Potassium intake was also underestimated by
419 mg/d (95% CI: 689, 149 mg/d) compared with the bio-
logical marker. However, the DH method showed good agreement
for the biological marker of urinary nitrogen excretion, with a
mean difference of 0.31 g/d (95% CI: 0.23, 0.85 g/d). The DH
method also showed good agreement for sodium intake and uri-
nary sodium excretion, with a mean difference of 198 mg/d
(95% CI: 538, 141 mg/d).
Dietary intake
Female vegans had significantly higher daily intakes of rice
(55 ± 47 g), legumes (300 ± 213 g), vegetables (325 ± 284 g),
whole-wheat bread (101 ± 59 g), and dietary supplements and
lower intakes of cake and cookies (13 ± 16 g) and candy and
chocolate (32 ± 51 g) than did female omnivores. Male vegans
had significantly higher daily intakes of legumes (335 ± 185 g),
vegetables (307 ± 127 g), nuts and seeds (8 ± 10 g), juice
(272 ± 263 g), and dietary supplements and lower intakes of cere-
als (9 ± 16 g) and candy and chocolate (22 ± 13 g) than did male
omnivores. No significant difference was observed between
groups for daily consumption of fruit and berries (161 ± 146 g);
white bread (71 ± 72 g); pizza, pie, and pastries (22 ± 32 g); chips
and popcorn (16 ± 18 g); soft drinks (326 ± 321 g); and alcoholic
beverages (111 ± 139 g).
Both vegans and omnivores obtained a large portion of energy
from between-meal snacks: 33% and 40%, respectively. Female
vegans obtained more energy from lunch (22%) and less from
snacks (33%) than did female omnivores (18% and 40%), and
male vegans obtained more energy from breakfast than did male
omnivores (21% and 15%, respectively), P < 0.05. Vegans had
lower dietary intakes (excluding supplements) of protein, satu-
Males
Omnivores (n = 15) Vegans (n = 15) Omnivores (n = 14)
0.92 ± 0.19 0.87 ± 0.19 0.85 ± 0.16
0.98 ± 0.13 1.14 ± 0.27 1.04 ± 0.14
1.02 ± 0.21 1.02 ± 0.32 1.15 ± 0.26
0.88 ± 0.19 1.02 ± 0.27 0.92 ± 0.18
rated fat, cholesterol, disaccharides, riboflavin, niacin, vitamin B-12,
vitamin D, calcium, phosphorus, zinc, and selenium than did
omnivores (Tables 2 and 3). On the other hand, vegans obtained
a higher percentage of total energy from carbohydrates than did
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omnivores and had higher intakes of polyunsaturated fat, mono-
saccharides, dietary fiber, folate, vitamin C, vitamin E, and mag-
nesium. Furthermore, female vegans had lower intakes of total
and monounsaturated fat and a higher intake of iron than did
female omnivores. Male vegans had lower intakes of alcohol and
sodium than did male omnivores.
The dietary intake (excluding supplements) of the omnivores
as a group was adequate for all nutrients, except selenium for
females (Table 3). Vegans had dietary intakes (excluding supple-
ments) that were lower than the average requirements of
riboflavin (males only), vitamin B-12, vitamin D (females only),
calcium, and selenium (Table 3). Intakes of calcium and sele-
nium remained low for vegans even after inclusion of intake
from dietary supplements. A significantly larger number of
vegans than omnivores used dietary supplements (26, or 87%,
compared with 13, or 43%), and there was no significant sex dif-
ference in either dietary group. Aside from multivitamin and
mineral supplements, 11 vegans (37%) and no omnivores con-
sumed vitamin B-12 supplements, and 6 vegans (20%) and no
omnivores consumed calcium supplements. Excluding multimin-
eral supplements, 3 (10%) of the omnivores and no vegans con-
sumed iron supplements.
The individual intakes (including supplements) of 19 vegans
(11 females) were below the lowest recommended intake level
for one or several nutrients. Five vegans had a low intake of vita-
min A, 5 of riboflavin, 11 of vitamin B-12, 7 of vitamin D, 1 of
iron (< 6.5 mg/d), 7 of calcium, 1 of zinc, and 17 of selenium.
One female omnivore had a low intake of selenium.
Nutritional assessment
Six (20%) female vegans and 7 (23%) female omnivores were
classified as having low iron status (Table 4). Three vegans had
low vitamin B-12 concentrations in blood; as a group, vegans
had lower vitamin B-12 and higher folate concentrations than did
omnivores (P < 0.01). Both dietary groups had iron-status vari-
ables and vitamin B-12 and folate concentrations within the ref-
erence range, according to the Clinical Chemistry Department,
University Hospital of Umeå, Umeå, Sweden.
 DIET AND NUTRITIONAL STATUS OF ADOLESCENTS 103

TABLE 2
Dietary intake of macronutrients (excluding supplements) of 30 vegans and 30 omnivores1
Females Males
Energy and Recommended Vegans Omnivores Recommended Vegans Omnivores
macronutrients intake2 (n = 15) (n = 15) intake (n = 15) (n = 15)
Energy (MJ) — 8.93 ± 2.18 9.52 ± 1.97 — 12.2 ± 1.68 13.2 ± 2.00
Protein
(g) 47 55 ± 173 80 ± 18 51 72 ± 133 117 ± 21
(% of energy) 10–15 10 ± 1.03 14 ± 1.3 10–15 10 ± 1.03 15 ± 1.7
Fat
Total (g) 73 58 ± 234 75 ± 22 100 88 ± 15 100 ± 22
(% of energy) < 30 24 ± 5.43 29 ± 3.8 < 30 27 ± 2.6 29 ± 4.2
Saturated (g) < 24 15 ± 6.83 34 ± 10 < 33 25 ± 5.53 45 ± 9.3
Monounsaturated (g) 30 20 ± 124 27 ± 8.0 42 32 ± 6.5 37 ± 8.7
Polyunsaturated (g) 18 15 ± 6.53 8.6 ± 2.9 25 21 ± 3.83 12 ± 3.7
Carbohydrates
(g) 310 340 ± 79 310 ± 62 430 456 ± 62 424 ± 75
(% of energy) 55–60 66 ± 5.33 56 ± 3.8 55–60 63 ± 3.23 55 ± 4.0
Alcohol
(g) 14 3.9 ± 4.4 4.9 ± 7.0 19 2.1 ± 3.14 7.0 ± 7.9
(% of energy) < 4.5 1.4 ± 1.6 1.6 ± 2.3 < 4.5 0.5 ± 0.74 1.6 ± 1.8
Cholesterol (mg) — 2.3 ± 2.43 230 ± 76 — 2.1 ± 2.93 326 ± 58
Monosaccharides (g) — 65 ± 284 48 ± 16 — 64 ± 195 47 ± 17
Disaccharides (g) — 72 ± 29 5
100 ± 29 — 77 ± 203 137 ± 40

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Sucrose (g) 54 69 ± 28 69 ± 22 75 73 ± 21 88 ± 36
Dietary fiber (g) 28 34 ± 113 21 ± 6.3 38 44 ± 103 25 ± 8.0
1–
x ± SD. Energy expenditure was measured by the doubly labeled water method in 7 female vegans (9.55 MJ), 7 female omnivores (11.2 MJ), 9 male
vegans (13.9 MJ), and 9 male omnivores (15.7 MJ). The Mann-Whitney U test was used for statistical comparisons between groups with different diets.
2
Recommended intake, according to the Nordic Nutrition Recommendations 1996 (8).
3–5
Significantly different from same-sex omnivores: 3 P < 0.001, 4 P < 0.05, 5 P < 0.01.

DISCUSSION
In accordance with other findings (19), male vegans weighed
less and had a lower BMI than male omnivores; in contrast, no
significant differences were seen between female vegans and
omnivores in the present study.
Validity of the dietary assessment
Energy intake was underreported (compared with measured
energy expenditure) by 14% of vegans and 12% of omnivores
(Table 1; 13). Thus, subjects underreporting energy intake prob-
ably had a higher than reported intake of nutrients; the opposite
would be true for subjects overreporting energy intake. A possi-
ble explanation for the lower reported-to-measured sodium ratio
of female vegans is that the salt content of vegan food items and
dishes in the food database is lower than is actually the case.
Potassium intake was underreported by 4% among vegans and
10% among omnivores, but even without adjusting reported
intake to account for underestimation, the potassium intake was
above the lowest recommended intake level of the Nordic Nutri-
tion Recommendations for all subjects.
Dietary intake and nutritional assessment
The higher intake of vegetables and legumes among vegans
than among omnivores confirms the results of another study of
lactoovovegetarian adolescents (20). However, the lactoovoveg-
etarians in that study ate less legumes and nuts (78 ± 73 g/d) and
vegetables (242 ± 147 g/d) and more sweets (149 ± 190 g/d) than
did the vegans in the present study, suggesting a healthier diet
among the Swedish vegans. A possible explanation for the lower
intake of candy and chocolate and cake and cookies among female
vegans than among female omnivores is that these food items
often contain animal products and that the range of comparable
vegan products is limited. In contrast with previous findings
(21–24), the vegans and omnivores in our study consumed simi-
lar amounts of alcoholic beverages. One exception was that male
vegans had a lower intake of alcohol (g/d) than did male omni-
vores. The observation that vegans and omnivores had similar
intakes of fruit and berries; white bread; pizza, pie, and pastries;
chips and popcorn; soft drinks; and alcoholic beverages may
indicate that in this respect, young “ethical vegans” differ from
the vegetarians who participated in previous studies, who proba-
bly were more health conscious (24). Also, the high SDs of the
food intake values in the present study imply heterogeneous
intakes, especially among female vegans, indicating that some
young vegans have good food habits and others do not.
Energy intake from snacks was higher than recommended
(25); these findings confirm those of a dietary survey of 731 ado-
lescents living in Umeå, Sweden (26). The lower intake of pro-
tein among vegans than among omnivores was consistent with
results from previous studies (27–30). A low protein intake was
reported to decrease urinary excretion of calcium (31–33), but a
recent study showed no association between intake of protein
and calcium absorption (34). The finding of lower intakes of
total and saturated fat and cholesterol among vegans than among
omnivores was in agreement with findings from other studies
(27–30). Together with higher intakes of polyunsaturated fat and
dietary fiber among vegans, this has health benefits, at least as
far as ischemic heart disease is concerned.
The higher prevalence of supplement use among vegans than
among omnivores verifies previous results (24, 35). To prevent
intakes that are lower than the average requirements of riboflavin
(for males), vitamin B-12, vitamin D (for females), calcium, and
104 LARSSON AND JOHANSSON

TABLE 3
Dietary intake of vitamins and minerals (excluding supplements) of 30 vegans and 30 omnivores1
Females Males
Vitamins Average Vegans Omnivores Average Vegans Omnivores
and minerals requirement2 (n = 15) (n = 15) requirement (n = 15) (n = 15)
Vitamin A (RE) 700 966 ± 683 1169 ± 588 750 1045 ± 273 1226 ± 309
Thiamine (mg) 0.9 1.5 ± 0.8 1.5 ± 0.5 1.1 1.9 ± 0.6 2.2 ± 0.5
Riboflavin (mg) 1.1 1.1 ± 0.53 1.9 ± 0.7 1.4 1.2 ± 0.64 2.8 ± 0.7
Niacin (NE) 12 26 ± 8.43 32 ± 8.0 15 34 ± 7.84 48 ± 9.5
Vitamin B-6 (mg) 1 2.1 ± 0.7 2.0 ± 0.6 1.3 2.7 ± 0.5 2.8 ± 0.6
Vitamin B-12 (g) 1.4 0.0 ± 0.14 5.0 ± 2.5 1.4 0.1 ± 0.034 5.9 ± 1.5
Folate (g) 120 473 ± 187 4
226 ± 73 140 551 ± 1424 263 ± 42
Vitamin C (mg) 30 178 ± 995 104 ± 44 30 203 ± 614 96 ± 32
Vitamin D (g) 2.5 2.0 ± 1.3 4
5.1 ± 1.6 2.5 3.7 ± 1.24 7.7 ± 2.2
Vitamin E (-TE) 3.0 13 ± 5.74 7.3 ± 2.8 4.0 18 ± 3.14 9.2 ± 2.2
Iron (mg) 10 14 ± 4.5 3
11 ± 3.0 8.5 18 ± 3.1 18 ± 4.8
Calcium (mg) 600 538 ± 3504 1328 ± 372 600 517 ± 1584 1697 ± 444
Phosphorus (mg) 450 1025 ± 3044 1536 ± 378 450 1361 ± 2804 2176 ± 408
Magnesium (mg) — 443 ± 1205 325 ± 77 — 559 ± 963 457 ± 105
Sodium (mg) — 2580 ± 986 3040 ± 614 — 3797 ± 8563 4656 ± 1108
Potassium (mg) 1600 3460 ± 1240 3160 ± 921 1600 4200 ± 863 4100 ± 694
Zinc (mg) 5 7.8 ± 2.25 11 ± 2.6 6 10 ± 2.44 16 ± 3.3
Selenium (g) 30 10 ± 3.04 27 ± 7.6 35 12 ± 2.14 40 ± 8.2
1–
x ± SD. RE, retinol equivalent; NE, niacin equivalent; -TE, -tocopherol equivalent. The Mann-Whitney U test was used for statistical comparisons

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between groups with different diets.
2
Average requirement, according to the Nordic Nutrition Recommendations 1996 (8). The average requirement of vitamin D was taken as 2.5 g, and
the lowest recommended intake was used for vitamin E.
3–5
Significantly different from same-sex omnivores: 3 P < 0.05, 4 P < 0.001, 5 P < 0.01.

selenium, the vegans were dependent on supplements. A study of 10–70 g/d because of low selenium content in the soil, and the
76 vegetarians (44 males, aged 27 y) showed that 73% of the lowest levels have been found in vegan diets comprising mostly
males had nonacceptable urinary riboflavin content, and the mean locally grown products (44). Supplementation of animal foods
intake of 50 subjects was 56% of the recommended allowance (36). with selenium has led to increased concentrations in meat, milk,
However, riboflavin need not be a problem in a well-planned and cheese (45, 46), indicating underestimated values of selenium
vegan diet because there are several vegan dietary sources, such content in these and possibly other food items included in the
as cornflakes, corn, spinach, and lentil sprouts (37). The vegans in
the present study had an intake of vitamin B-12 from diet that was
lower than the average requirement, and long-term vegans are TABLE 4
advised to include vitamin B-12–fortified foods or dietary sup- Iron-status, vitamin B-12, and folate assessment of female vegans and
plements in their diets (38). The differences in concentrations of omnivores1
vitamin B-12 and folate between the vegans and omnivores con- Vegans (n = 15) Omnivores (n = 15)
firm findings of other studies (39, 40). One of the 3 vegans with n (%)
low vitamin B-12 concentrations took B-12-supplements, indicat-
Early negative iron balance2 1 (6.6) 1 (6.6)
ing a failure in absorption rather than low intake. A possible
Iron depletion3 3 (20) 2 (13)
explanation is a lack or insufficient amounts of intrinsic factor Iron-deficient erythropoiesis4 1 (6.6) 1 (6.6)
needed for absorption (38, 41). Female vegans had dietary intakes Iron deficiency anemia5 1 (6.6) 3 (20)
of vitamin D that were lower than the average requirement, but Inadequate serum vitamin 1 (6.6) 0
the vitamin is also obtained via endogenous production when B-12 concentration6
skin is exposed to ultraviolet light. If exposure to sunlight is 1
No significant same-sex differences were found between vegans and
inadequate, which may be the case in northern Sweden between omnivores with the use of the Mann-Whitney U test. Two (13%) male
November and February, fortified foods such as soy drinks and vegans had inadequate serum vitamin B-12 concentrations. All other males,
some cereals or supplements of vitamin D may be needed for veg- both vegans and omnivores, had adequate blood concentrations of iron-
ans (37). Vegans had a lower intake of calcium than did omni- status variables and folate.
vores, which confirms previous findings for female vegans (42)
2
Plasma iron: < 21.5 mol/L; total-iron-binding capacity: 53.7–64.5 mol/L;
but is in contrast to those for male vegans (27). Vegans in the transferrin saturation: 30%; plasma ferritin: < 25 g/L (18).
present study relied on dietary supplements and calcium-fortified
3
Plasma iron: < 20.6 mol/L; total-iron-binding capacity: 64.5 mol/L;
transferrin saturation: 30%; plasma ferritin: < 20 g/L (18).
fluids to make up 35% of their calcium intake; omnivores 4
Plasma iron: < 10.7 mol/L; total-iron-binding capacity: 69.8 mol/L;
obtained 69% of their calcium from milk products. Vegans need transferrin saturation: < 15%; plasma ferritin: < 10 g/L (18).
to replace milk products with calcium-rich vegan foods such as 5
Plasma iron: < 7.2 mol/L; total-iron-binding capacity: 73.4 mol/L;
semolina, tofu, and fortified soy drinks and consume sizable serv- transferrin saturation: < 15%; plasma ferritin: < 10 g/L (18).
ings of leafy green vegetables such as kale and broccoli (37, 43). 6
Serum vitamin B-12: < 95 pmol/L. All subjects had adequate folate
The dietary intake of selenium in Sweden is estimated to be concentrations (< 3.4 nmol/L).
 DIET AND NUTRITIONAL STATUS OF ADOLESCENTS
database. By eating products grown outside Sweden, such as
lentils, nuts, and cereals (47), grown on selenium-rich soil, vegans
may increase selenium intake.
Female vegans had a higher iron intake (excluding supple-
ments) than female omnivores, which does not support a previ-
ous finding (28). However, intake was similar when including
supplements. Low iron status was as frequent among omnivores
as among vegans, despite the vegans’ intake of nonheme iron
only, which has a lower absorption rate than does heme iron (48),
and higher intakes of dietary fiber and possibly phytic acid,
which decrease the bioavailability of iron (8, 47). This result is
in agreement with one previous study (28) but not with others
(29, 49). The prevalence of low iron status was similar to results
of other Swedish studies on adolescents (50, 51). Only females
had low iron status because their intakes were lower and their
iron requirements higher than those of males (8). Iron bioavail-
ability may be increased by combining iron intake with intake of
food items high in vitamin C and by decreasing intake of phytic
acid, through, for instance, yeast fermentation of whole-wheat
flours when baking bread, and by minimizing intake of the tan-
nins found in tea and coffee (37).
For 11 of the 20 individuals with nutrient intakes lower than
the average requirements, energy intake was validated with
DLW. Five of these had a reported energy intake/measured
energy expenditure value of < 0.80, indicating underreporting as
a likely explanation for the low intake. However, the low intake
of iron of one female vegan could not be explained by underre-
porting because it was confirmed by a low iron status.
The vegan diet of adolescents was very heterogeneous and did
not comply with the average requirements for riboflavin,
vitamin B-12, vitamin D, calcium, and selenium when supple-
ments were excluded from the calculations. Intakes of calcium
and selenium remained lower than the average requirements even
after inclusion of supplements. The prevalence of insufficient iron
status was as high among omnivores (23% of females) as among
vegans (20% of females), indicating a female rather than a vegan
problem. It is important for adolescents in general and vegetari-
ans in particular to receive knowledge, both theoretical and prac-
tical, about how to combine and prepare a healthy diet.
We thank all the adolescents who participated and Linda Hagfors and
Maria Hedström for valuable help with data entry.
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