Plant-Based Drinks as an Alternative to Cow's Milk in Early Life: Health Effects in Infancy, Childhood, and Adolescence.

backgroundPlant-based milk alternatives (PBMA) are increasingly being consumed as a supplement to or replacement for cow's milk, even in infancy and childhood. Their effects on later health and growth have been insufficiently studied. We analyze the available evidence concerning the effects of PBMA consumption on health and growth in infants, children, and adolescents.

methodsThis review is based on publications retrieved by a structured literature search on health and growth outcomes of PBMA consumption in infancy, childhood, and adolescence.

resultsComparative cross-sectional and cohort studies have shown that the intake of nutrients typically found in cow's milk, such as iodine, is lower with exclusive consumption of PBMA. Even the partial replacement of cow's milk by PBMA is associated with reduced linear growth and a lower body-mass index (BMI). The height-for-age z-score was -0.04 [-0.07; -0.01] and the BMI-for-age z-score was -0.06 [-0.09; -0.03] for each cup of PBMA in five-year-olds, corresponding to reductions of 0.2 cm in height and 0.1 kg in weight. There have been case reports of severe malnutrition and undernutrition from the exclusive or predominant consumption of PBMA, mainly in the first two years of life, but the informational value of these reports is limited. Our search did not retrieve any longitudinal studies on long-term outcomes or any randomized intervention trials comparing the consumption of cow's milk and PBMA.

conclusionHigh PBMA consumption in early life may increase the risk of health impairment. The low methodological quality of the available evidence, along with residual confounding, makes the risk hard to quantify. Recommendations regarding PBMA consumption must be differentiated by life phase. Age-related special nutritional requirements must be met, and this is particularly important in early life. More research on long-term outcomes is needed.