A vegetarian diet is associated with worse health indicators for children across a range of indicators, new evidence from an official national health survey shows. However, in the absence of unit-level data, it is not possible to say if these children’s poor health is due to deficiencies from their vegetarian diet, or because of other characteristics unrelated to vegetarianism.

The Comprehensive National Nutrition Survey (CNNS) 2016-2018 is a nationally representative sample survey conducted by the ministry of health and family welfare, which covered over 100,000 children across India up to the age nine, and adolescents between the age of 10 and 19 years. The survey collected primary data on anthropometric measures, micronutrient deficiencies and the risk of non-communicable diseases.

As part of its investigations into children’s diets, CNNS asked mothers whether they, or their child, consumed eggs and/or meat in the week before the survey. The results suggest that more than half of all Indian children are self-reported vegetarians. For the mothers of children aged 0-4, the share is closer to 45%. This is a far higher reported share of vegetarianism than in previous major national surveys, such as the 2015-16 National Family Health Survey.

Within India, as is now well-known, the southern and eastern states, which have better child health outcomes, have more meat-eaters, while the northern states are more vegetarian.

On most key health indicators, children with a non-vegetarian diet have the best outcomes, followed by those who are vegetarian, but eat eggs. Children with non-vegetarian mothers are less likely to be stunted or underweight, but in most cases, the advantage is not large. There are a few stray exceptions. For instance, there are more children aged 0-4 born to non-vegetarians who are wasted (low weight-for-height), and more non-vegetarian 10-19 year-olds with zinc deficiency.

Non-vegetarian children, though, are at greater risk of being overweight or obese, and of developing non-communicable and ‘lifestyle’ diseases.

This is in line with what is known about the health risks of eating excessive meat and animal fats.

But all this need not mean that it is a vegetarian diet that causes relatively poorer health outcomes. Without unit-level data, it’s difficult to attribute this causality, especially since there are other factors, such as income, that could affect health outcomes. In India, the consumption of meat rises with income until the middle of India’s income distribution, implying that as families get the money to purchase animal protein, they buy more of it.

However, from the middle of the income distribution, this figure begins to fall, which is likely an effect of caste. There is a strong overlap between higher incomes and the likelihood of being upper caste in India. Vegetarianism is far more a feature of upper castes, particularly Brahmins, than of any other caste group or community.

In the CNNS, the rich have better health outcomes than the poor, and OBCs and “others" have better health indicators than children belonging to the Scheduled Castes and Scheduled Tribes.

As a result, it is not immediately clear whether incomes or dietary preferences are playing a stronger role in determining health outcomes.

The National Institute of Nutrition’s dietary guidelines recommend that Indians, particularly young children and pregnant women, consume animal proteins, which are considered better quality than plant-based proteins and contain certain micronutrients that a vegetarian diet might not provide. However, the guidelines add that the consumption of some cereals and milk can deliver the same result .

Globally, nutritionists are increasingly recommending replacing animal protein intake with plant-based foods. But given what is known about Indian’s protein deficiencies as against the global recommended standard, as well as the poorer health outcomes of its vegetarian children, in India’s case, it may not yet be the best solution.

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