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

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.