Plant-Based Diets in Adolescence: Cardiometabolic Benefits, Developmental Risks, and the Role of Fortification

Abstract

Adolescence is a critical window in which dietary patterns stabilise while nutrient requirements remain high to support growth, bone accrual, and neurodevelopment. Plant-based diets are increasingly adopted by young people, yet paediatric evidence indicates that they should not be treated as a single exposure, because diet quality substantially modifies both benefits and risks. Healthy plant-based patterns—rich in whole grains, legumes, fruits, vegetables, nuts, and unsaturated fats—are associated with more favourable blood pressure, glycaemia, lipids, adiposity, and insulin sensitivity in adolescents, whereas patterns built on refined grains, sugar-rich foods, and ultra-processed plant products are associated with the opposite profile. Recent paediatric meta-analyses identify recurrent vulnerabilities for vitamin B12, iron, zinc, calcium, and vitamin D, alongside a leaner phenotype that includes lower bone mineral content and, in vegans, shorter stature. The commercial food environment is a further determinant: audits of plant-based meat alternatives show that most are ultra-processed, that salt frequently exceeds national targets, and that only a minority are fortified. Much adolescent-specific evidence remains low-certainty and cross-sectional. The relevant question is therefore not whether plant-based diets are beneficial or harmful in adolescence, but under which conditions they improve cardiometabolic health without compromising growth, bone accrual, or micronutrient sufficiency.