Jennifer Stranges

A study of nearly 9,000 children has found those who eat a vegetarian diet had similar measures of growth and nutrition compared to children who eat meat.

The study, led by researchers at the 91�Թ� and St. Michael’s Hospital of Unity Health Toronto, also found that children with a vegetarian diet had higher odds of underweight status – emphasizing the need for special care when planning the diets of vegetarian kids.

The findings, published in the journal Pediatrics, come as a shift to consuming plant-based diets grows in Canada. In 2019, updates to Canada’s Food Guide urged Canadians to embrace plant-based proteins, such as beans and tofu, instead of meat.

Professor Jonathon Maguire (photo courtesy of St. Michael's Hospital, Unity Health Toronto)

“Over the last 20 years we have seen growing popularity of plant-based diets and a changing food environment with more access to plant-based alternatives, however we have not seen research into the nutritional outcomes of children following vegetarian diets in Canada,” said Jonathon Maguire, principal investigator on the study who is a professor in 91�Թ�’s department of pediatrics in the Temerty Faculty of Medicine and a pediatrician at St. Michael’s Hospital.

“This study demonstrates that Canadian children following vegetarian diets had similar growth and biochemical measures of nutrition compared to children consuming non-vegetarian diets,” said Maguire, who is also a scientist at 91�Թ�’s Joannah & Brian Lawson Centre for Child Nutrition. “Vegetarian diet was associated with higher odds of underweight weight status, underscoring the need for careful dietary planning for children with underweight when considering vegetarian diets.”

The researchers evaluated 8,907 children aged six months to eight years. The children were all participants of the TARGet Kids! cohort study and data was collected between 2008 and 2019. Participants were categorized by vegetarian status – defined as a dietary pattern that excludes meat – or non-vegetarian status.

The team found children who had a vegetarian diet had similar mean body mass index (BMI), height, iron, vitamin D and cholesterol levels compared to those who consumed meat. The findings showed evidence that children with a vegetarian diet had almost two-fold higher odds of having underweight, which is defined as below the third percentile for BMI. There was no evidence of an association with overweight or obesity.

Underweight is an indicator of undernutrition, and may be a sign that the quality of the child’s diet is not meeting the child’s nutritional needs to support normal growth. For children who eat a vegetarian diet, the researchers emphasized access to health-care providers who can provide growth monitoring, education and guidance to support their growth and nutrition.

International guidelines about vegetarian diet in infancy and childhood have differing recommendations, and past studies that have evaluated the relationship between vegetarian diet and childhood growth and nutritional status have had conflicting findings.

“Plant-based dietary patterns are recognized as a healthy eating pattern due to increased intake of fruits, vegetables, fiber, whole grains and reduced saturated fat; however, few studies have evaluated the impact of vegetarian diets on childhood growth and nutritional status. Vegetarian diets appear to be appropriate for most children,” said Maguire, who is also a scientist at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital.

A limitation of the study is that researchers did not assess the quality of the vegetarian diets. The researchers note that vegetarian diets come in many forms and the quality of the individual diet may be quite important to growth and nutritional outcomes. The authors say further research is needed to examine the quality of vegetarian diets in childhood, as well as growth and nutrition outcomes among children following a vegan diet, which excludes meat and animal derived products such as dairy, eggs and honey.

The study was funded by the Canadian Institutes of Health Research (CIHR), St. Michael’s Hospital Foundation and SickKids Foundation.

A version of this story was first published on the website of St. Michael's Hospital, Unity Health Toronto.

Male physicians refer patients to male surgeons at disproportionate rates: 91�Թ� study

Christopher.Sorensen — Thu, 11 Nov 2021 14:20:24 +0000

Male physicians refer patients to male surgeons at disproportionate rates: 91�Թ� study

Christopher.Sorensen Thu, 11/11/2021 - 09:20

Cutline

(Photo by Morsa Images via Getty Images)

Jennifer Stranges

Topic

Breaking Research

Temerty Faculty of Medicine

Institute of Health Policy Management and Evaluation

Dalla Lana School of Public Health

Research & Innovation

St. Michael's Hospital

A study that analyzed nearly 40 million referrals to surgeons in Ontario found male physicians disproportionately refer patients to male surgeons over similarly qualified and experienced female surgeons.

The study, published this week in JAMA Surgery, showed that the differences in referral volumes and types could not be explained by patients’ choices or by characteristics of the surgeon, including age or experience.

The findings suggest that male physicians hold biases that disadvantage female surgeons, further widening the gender pay gap in medicine.

“During my 20 years in practice, I always had the sense it was easier for my male surgical colleagues to get referrals than it was for me, and the patients they were referred were more likely to need surgery,” said Nancy Baxter, senior author on the study.

“Our work demonstrates that my observations were not unique but reflect gender bias that affects the lives and livelihoods of all female surgeons in the province.”

A professor of surgery at the 91�Թ�’s Temerty Faculty of Medicine. Baxter is also affiliated with the Institute of Health Policy, Management and Evaluation at the Dalla Lana School of Public Health and St. Michael’s Hospital at Unity Health Toronto.

The researchers compared the proportion of referrals made by male and female physicians to male and female surgeons over a 10-year span from 1997 to 2016. Nearly 40 million referrals were made to 5,660 surgeons. Although male surgeons accounted for 77.5 per cent of all surgeons, they received 79 per cent of referrals sent by female physicians – and 87 per cent of referrals sent by male physicians.

The study found female physicians were 1.6 per cent likelier to refer patients to a female surgeon. Male physicians, meanwhile, were 32 per cent likelier to refer patients to a male surgeon. The differences were greatest in surgical specialties with the highest representation of female surgeons, including gynecology and plastic surgery.

Moreover, that gap remained as more women entered surgery over the study’s 10-year span.

Fahima Dossa (photo by Perry King)

“There is an often-made assumption that sex-based inequities in medicine will naturally improve as more women enter medicine and acquire experience,” said Fahima Dossa, co-lead author of the study and a general surgery resident based at St. Michael’s Hospital. “In contrast, our study demonstrates that inequities will not improve without active intervention – the specialties with the greatest representation of female surgeons, for example gynecology, exhibited the greatest degree of referral disparities.”

The authors say the findings demonstrate the need for efforts directly focused on eliminating sex-based biases within medicine. Dossa suggests innovative changes to the referral process, such as a single-entry referral model, in which referrals are scheduled to be seen by the first surgeon available.

The research builds on previous work by Baxter and Dossa that found female surgeons in Ontario earn 24 per cent less per hour while operating compared to male surgeons, and that female surgeons performed fewer of the highest-paid primary procedures than male surgeons.

“The time is now ripe to enact change,” Dossa said. “Our work points toward a mechanism that directly contributes to the sex-based pay gap in medicine. Focused efforts at reducing the effects of implicit and explicit biases on referrals to physicians are now needed.”

This work included researchers at the independent, non-profit research institute ICES, and was funded by the Canadian Institutes of Health Research and the Physicians’ Services Inc. Foundation.