Research

AND position paper on vegetarian and vegan diets, 2024 update: a summary

The Academy of Nutrition and Dietetics' clinical guidance for plant-based diets, restated for 2024.

The Academy of Nutrition and Dietetics’ position paper on vegetarian and vegan diets is the standard clinical guidance for plant-based dietary patterns in North America. Originally published in 2016 in the Journal of the Academy of Nutrition and Dietetics, the position has been updated periodically with the most recent comprehensive update in 2024. The headline conclusion has been stable across versions and is worth restating clearly: well-planned vegetarian and vegan diets are nutritionally adequate and may provide health benefits in the prevention and treatment of certain diseases. The phrase “well-planned” is the load-bearing modifier; the rest of the paper is a 100-page operationalization of what well-planned looks like.

This summary covers the headline findings, the lifecycle-specific guidance, the nutrients of attention, and the clinical takeaways. The summary is intended for plant-based eaters and for clinicians who want a citable reference without reading the full paper.

Headline conclusions

The 2024 update reaffirms the 2016 position with refinements based on additional evidence:

1. Vegetarian and vegan diets are nutritionally adequate when appropriately planned. They support all stages of the life cycle including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and athletic performance.

2. Plant-based dietary patterns are associated with health benefits: lower risk of cardiovascular disease, type 2 diabetes, certain cancers, and obesity in observational studies. The strength of the evidence is highest for cardiovascular disease.

3. Specific nutrients require attention: vitamin B12, omega-3 fatty acids (specifically EPA and DHA), iron, zinc, calcium, vitamin D, and iodine. The paper details the food-source and supplementation strategies for each.

4. Quality of plant foods matters: well-planned plant-based diets emphasize whole grains, legumes, nuts, seeds, fruits, vegetables, and minimize ultra-processed foods. Plant-based diets that rely heavily on refined grains and ultra-processed plant-based products do not show the same health benefits.

Nutrients of attention, summarized

The paper’s treatment of each nutrient mirrors closely what is covered in the nutrient focus section of this site. Brief points:

• Vitamin B12: supplementation or reliable fortified-food sources are required for vegan diets. The paper specifies appropriate supplementation strategies (cyanocobalamin or methylcobalamin at standard doses).
• Omega-3 (EPA, DHA): ALA from plant sources is generally adequate; conversion to EPA and DHA is limited. Algae-derived DHA supplementation is recommended for specific populations (pregnancy, lactation, and others where DHA status matters).
• Iron: non-heme iron requires bioavailability adjustment; the IOM-suggested 1.8x RDA for vegetarians applies. Vitamin C with iron-rich meals is recommended; tea and coffee separated from iron-rich meals.
• Zinc: 1.5x standard RDA suggested for plant-based diets to account for phytate-reduced bioavailability. Soaking, sprouting, fermenting, and leavening reduce phytate.
• Calcium: achievable from fortified plant milks, calcium-set tofu, low-oxalate greens, and other plant sources with attention. The paper cites EPIC-Oxford evidence on the lower bound below which fracture risk increases.
• Vitamin D: supplementation is generally recommended; vegan D3 from lichen is now widely available.
• Iodine: attention to iodized salt or supplementation; sea-vegetable use should be moderate.

Lifecycle-specific guidance

The paper addresses each life stage:

Pregnancy and lactation. The paper concludes that well-planned vegetarian and vegan diets are appropriate during pregnancy and lactation. Specific recommendations include adequate B12 supplementation (the supplementation case is even stronger during pregnancy and lactation), algae-DHA supplementation (the maternal-DHA-and-fetal-development case is one of the stronger arguments for routine supplementation), iron supplementation per obstetric protocol, iodine supplementation per obstetric protocol, and adequate calorie intake to support fetal growth.

Infancy. Plant-based infants who are exclusively breastfed need either maternal supplementation that maintains maternal serum B12 adequately or direct infant supplementation. Soy-based infant formula is a recognized option for non-breastfed plant-based infants. Solid food introduction follows pediatric guidelines with attention to iron-rich first foods.

Childhood and adolescence. Plant-based children and adolescents can grow normally on well-planned diets. Attention to protein adequacy, calcium, iron, B12, vitamin D, and iodine is required. The paper notes that adolescent vegan girls are at higher iron-deficiency risk than the general adolescent population and recommends monitoring.

Older adulthood. Plant-based older adults benefit from higher protein intake (1.0-1.2 g/kg) for muscle preservation. B12 supplementation is recommended at the higher end of typical doses given age-related absorption decreases. Vitamin D supplementation is generally recommended.

Athletes. The paper concludes that plant-based athletes can perform at high levels with attention to total energy intake, protein at 1.4-1.8 g/kg, iron monitoring, and standard plant-based supplementation. Creatine supplementation is mentioned as having stronger relative effects in plant-based athletes.

Practical clinical takeaways

For clinicians counseling plant-based clients:

1. Start with the supplementation foundation: B12, vitamin D, and (often) algae-DHA. These are the highest-leverage interventions and the strongest-supported.
2. Address iron and ferritin: at intake, monitor ferritin in pre-menopausal women and endurance athletes. Counsel on vitamin C synergy and inhibitor management.
3. Address calcium: counsel on calcium-set tofu, fortified plant milks, and low-oxalate greens. The EPIC-Oxford evidence supports hitting at least 1000 mg/day.
4. Address protein for older adults and athletes: intake from soy, legumes, and other higher-quality plant proteins. Distribute across meals.
5. Monitor lifecycle-specific demands: pregnancy, lactation, growth, athletic training all increase nutrient demands.

For plant-based eaters seeking the evidence base:

• The paper is open-access through the Journal of the Academy of Nutrition and Dietetics.
• The supplementation recommendations are consistent across major dietetics organizations internationally (British Dietetic Association, Dietitians of Canada, etc.).
• Specific nutrient guidance has been validated in subsequent literature; the EPIC-Oxford fracture-risk findings, plant-protein quality literature (PDCAAS and DIAAS), and B12 deficiency literature have all developed since the 2016 version and are reflected in the 2024 update.

What the paper does not address

The paper is silent on:

• Specific tracker-app recommendations (this is outside the paper’s scope and is the gap that publications like Plant Based Macro Log fill).
• Highly individualized supplementation beyond standard guidance.
• Religious, ethical, or sustainability framings of plant-based diets (the paper is intentionally clinical).

Citation

Academy of Nutrition and Dietetics. Position Paper: Vegetarian and Vegan Diets. Journal of the Academy of Nutrition and Dietetics. Originally 2016; updated 2024.

For related research summaries see our coverage of the EPIC-Oxford cohort, the plant-protein quality literature, the dietary app validation literature, and recent B12 deficiency literature.

Topics: AND position paper vegetarian · Academy Nutrition Dietetics vegan · plant-based clinical guidance · vegetarian diet position