Study reveals most plant-based milks don’t meet toddlers’ nutrient needs

Can a plant-based drink match milk for toddlers? New research reveals that most don’t—unless they’re specially fortified.

Study: Replacing cow’s milk with plant-based drinks: consequences for nutrient intake of young children on a balanced diet in Germany. Image Credit: Cast Of Thousands / Shutterstock

In a recent study published in the Journal of Health, Population, and Nutrition, researchers examined the consequences of replacing cow’s milk with plant-based drinks on the nutrient intake of young children aged 1–3 years consuming the German Optimized Mixed Diet (OMD).

Cow’s milk (henceforth, milk) has been a traditional component of children’s nutrition in Western countries. It contains high-quality protein, vitamins, minerals, and bioactive compounds, supporting growth and development. Recently, there has been a paradigm shift in dietary habits worldwide, considering sustainability and planetary health. As such, this would mean an increase in plant-based alternatives in typical Western diets at the expense of animal foods.

Consequently, current dietary guidelines for children should be reviewed to consider replacing dairy products with plant-based substitutes. Infant nutrition throughout early childhood transitions into a mixed family diet, comprising common foods such as milk and related products. According to the child nutrition guidelines in Germany, the dietary schedule in the first year of life transitions to an Optimized Mixed Diet (OMD), covering ages 1–18 years.

The OMD is based on a seven-day menu that considers the food habits of German families, featuring three main meals and two snacks per day. Home-cooked meals and nutrient-dense foods are preferred, with highly processed foods accepted occasionally. The nutrient densities of the seven-day menu ensure that individuals aged 1–18 meet the German reference values for micro- and macronutrients. In the OMD, the daily intake of fluid milk is 219 grams, which served as the basis for the substitution scenarios in the study.

The study and findings

In the present study, researchers investigated scenarios of the OMD in which the fluid milk component of the OMD (219 g/day) was replaced with plant-based drinks and their consequences on the nutrient intake of young children. The products for OMD scenarios had to 1) represent legumes, cereals, and nuts, 2) include plant-based drinks for infants and young children, and 3) provide comprehensive information on composition.

For OMD scenarios, fluid milk in the seven-day menu for children aged 1–3 was replaced with select plant-based alternatives, while other food and drinks remained unchanged. Nutrients typical of dairy products, such as vitamins, calcium, and protein, as well as essential nutrients for young children (iodine and iron), were selected for nutritional assessment. The daily energy and nutrient intake with the modified menus was compared to the original OMD.

The team used six different drinks made from nuts (almonds), cereals (oats), and legumes (soy) in three categories: basic (non-fortified), fortified, and special products for children. Special products for children included a soy-based formula (for medical indications) and a growing-up drink, which EFSA does not deem essential but potentially helpful in improving intake of iron and iodine.

The six drinks were a basic soy drink, a fortified soy drink, a fortified almond drink, a basic oat drink, a soy formula, and a growing-up drink. The energy and nutrient contents varied significantly across the drinks. The energy content of the common drinks was comparable to that of low-fat milk, whereas the two products intended for children had similar energy content to whole milk. Almond and oat drinks had significantly lower protein compared to milk.

In contrast, protein content in soy drinks was comparable to milk, except for soy formula, which had lower protein. While protein quantity was maintained, the quality varied, with soy drinks most closely resembling milk. Fortified products and the growing-up drink were close to milk in terms of calcium, vitamin B2, and vitamin B12 content. In non-fortified products, these micronutrients were hardly present. Due to multiple fortifications, the special products were markedly enriched in micronutrients, including iron and iodine.

Milk replacement had a minimal impact on energy intake (<10%) and protein quantity, but varied consequences for micronutrients. With non-fortified drinks, the daily intake of vitamin B2, calcium, vitamin B12, and iodine was reduced to half that of the original OMD. The nutrient supply from fortified drinks was maintained to nearly the same extent as OMD, except for iodine, which was rarely fortified in market-available drinks, even among fortified products across all categories including soy, oat, and almond. With special drinks, the nutrient supply of the OMD was attainable and even significantly increased for iodine and iron, but only in specialized children’s products; other plant-based drinks failed to meet iodine needs.

Conclusions

In summary, replacing milk with plant-based alternatives would result in a slight reduction in energy intake (<10%) and a significant decrease in important micronutrients found in milk. Moreover, the consequences on nutrient supply were less dependent on the plant source and more strongly influenced by the degree of fortification by manufacturers. The non-fortified products, which comprised the majority (about 80%) of products in a 2024 German market survey, are often referred to as organic products. This is due in part to European Union regulations on organic food (EU Regulation 2018/848), which restrict the addition of vitamins and minerals, thereby limiting fortification.

The fortification of these organic products has been made difficult by protective regulations. However, because the label “organic” is perceived to be associated with health benefits, it may be challenging to inform parents that such products could be nutritionally inadequate in some cases. The study’s limitation was that the nutrient contents were inferred from product labels and not confirmed by a chemical analysis. Additionally, the bioavailability of fortified nutrients, such as calcium and iron, may differ from those in cow’s milk, depending on the food matrix and fortification compounds used.