To ascertain the association between soya consumption, isoflavone intakes and oesophageal cancer risk in remote north-west China, where the incidence of oesophageal cancer is known to be high.

Case–control study. Information on habitual consumption of soya foods and soya milk was obtained by personal interview. The intakes of isoflavones were then estimated using the US Department of Agriculture nutrient database. Logistic regression analyses were performed to assess the association between soya consumption, isoflavone intakes and oesophageal cancer risk.

Urumqi and Shihezi, Xinjiang Uyghur Autonomous Region, China.

Participants were 359 incident oesophageal cancer patients and 380 hospital-based controls.

The oesophageal cancer patients consumed significantly less (P < 0·001) total soya foods (mean 57·2 (sd 119·0) g/d) and soya milk (mean 18·8 (sd 51·7) ml/d) than the controls (mean 93·3 (sd 121·5) g/d and mean 35·7 (sd 73·0) ml/d). Logistic regression analyses showed an inverse association between intake of soya products and the risk of oesophageal cancer. The adjusted odds were OR = 0·33 (95 % CI 0·22, 0·49) and OR = 0·48 (95 % CI 0·31, 0·74) for consuming at least 97 g of soya foods and 60 ml of soya milk daily (the highest tertiles of consumption), respectively, relative to the lowest tertiles of consumption. Similarly, inverse associations with apparent dose–response relationships were found between isoflavone intakes and oesophageal cancer risk.

Habitual consumption of soya products appears to be associated with reduced risk of oesophageal cancer in north-west China.

To evaluate the greenhouse gas emission (GHGE) of diets in Dutch girls, boys, women and men and to explore associations with diet composition.

Descriptive analyses for the total population as well as stratified for gender, age and dietary environmental load.

The Netherlands.

Dutch children and adults aged 7–69 years (n 3818).

The GHGE of daily diets was on average 3·2 kg CO2-equivalents (CO2e) for girls, 3·6 kg CO2e for boys, 3·7 kg CO2e for women and 4·8 kg CO2e for men. Meat and cheese contributed about 40 % and drinks (including milk and alcoholic drinks) 20 % to daily GHGE. Considerable differences in environmental loads of diets existed within age and gender groups. Persons with higher-GHGE diets consumed more (in quantity of foods and especially drinks) than their counterparts of a similar sex and age with low-GHGE diets. Major differences between high- and low-GHGE diets were in meat, cheese and dairy consumption as well as in soft drinks (girls, boys and women) and alcoholic drinks (men). Of those, differences in meat consumption determined the differences in GHGE most. Diets with higher GHGE were associated with higher saturated fat intake and lower fibre intake

GHGE of daily diets in the Netherlands is between 3 and 5 kg CO2e, with considerable differences between individuals. Meat, dairy and drinks contribute most to GHGE. The insights of the study may be used in developing (age- and gender-specific) food-based dietary guidelines that take into account both health and sustainability aspects.

The epidemiology of family meals among adults at a population level is poorly characterized and whether living with children impacts this health behaviour is uncertain. We determined the prevalence of family meals among US adults in a mid-western state whose families did and did not include minor children and described how it varied by sociodemographic characteristics.

The cross-sectional 2012 Ohio Medicaid Assessment Survey is representative of Ohio adults and included questions on their sociodemographic characteristics and the frequency with which they eat family meals at home.

Trained interviewers administered landline and cell phone surveys to adults sampled from Ohio’s non-institutionalized population.

We analysed data from 5766 adults living with minor children and 8291 adults not living alone or with children.

The prevalence of family meals was similar for adults who did and did not live with minor children: 47 % (95 % CI 46, 49 %) of adults living with and 51 % (95 % CI 50, 53 %) of adults living without children reported eating family meals on most (six or seven) days of the week. Family meal frequency varied by race/ethnicity, marital and employment status in both groups. Non-Hispanic African-American adults, those who were not married and those who were employed ate family meals less often.

Adults in Ohio frequently shared meals with their family and family meal frequency was not strongly related to living with children. Broadening the scope of future studies to include adults who are not parents could enhance our understanding of the potential health benefits of sharing meals.

We aimed to use the meta-analysis method to assess the relationship between coffee drinking and all-cause mortality.

Categorical and dose–response meta-analyses were conducted using random-effects models.

We systematically searched and identified eligible literature in the PubMed and Scopus databases.

Seventeen studies including 1 054 571 participants and 131 212 death events from all causes were included in the present study.

Seventeen studies were included and evaluated in the meta-analysis. A U-shaped dose–response relationship was found between coffee consumption and all-cause mortality (P for non-linearity <0·001). Compared with non/occasional coffee drinkers, the relative risks for all-cause mortality were 0·89 (95 % CI 0·85, 0·93) for 1–<3 cups/d, 0·87 (95 % CI 0·83, 0·91) for 3–<5 cups/d and 0·90 (95 % CI 0·87, 0·94) for ≥5 cups/d, and the relationship was more marked in females than in males.

The present meta-analysis of prospective cohort studies indicated that light to moderate coffee intake is associated with a reduced risk of death from all causes, particularly in women.

Limited observational studies have considered habitual consumption of the general population to examine the relationship between the Dietary Approaches to Stop Hypertension (DASH) diet and obesity. The aim of the present study was to investigate adherence to the DASH diet in relation to general and central obesity among female nurses in Isfahan, Iran.

Cross-sectional study carried out among 293 female nurses aged >30 years who were selected by a multistage, cluster random sampling method. Usual dietary intakes were assessed using a validated FFQ. We constructed the DASH score based on foods and nutrients emphasized or minimized in the DASH diet, focusing on eight components: high intake of fruits, vegetables, nuts and legumes, low-fat dairy products and whole grains and low intakes of sodium, sweetened beverages, and red and processed meats. General and abdominal obesity were defined as BMI ≥25 kg/m2 and waist circumference ≥88 cm, respectively.

Isfahan, Iran.

Female nurses (n 293) aged >30 years.

Increased adherence to the DASH diet was associated with older age (P<0·01) and lower waist circumference (P=0·04). There was no statistically significant difference in the prevalence of general obesity between extreme quartiles of the DASH diet score. After adjustment for age, energy intake and other confounding factors, DASH diet score was not significantly associated with obesity. However, with further controlling for other dietary factors, those in the highest quartile of DASH diet score were 71 % less likely to have general obesity compared with those in the lowest quartile. In addition, following a DASH diet was inversely associated with central obesity after adjustment for potential confounders (OR=0·37; 95 % CI 0·14, 0·96).

We found that adherence to the DASH diet was inversely related to central obesity among Iranian adult females. This association remained significant even after adjustment for potential confounders.

We aimed to examine the association between red meat consumption and stroke in a group of Iranian adults.

A hospital-based case–control study.

The study included stroke patients and hospital-based controls. Usual dietary intakes of participants were assessed by means of a validated 168-item semi-quantitative FFQ. Total red meat consumption was calculated by summing up the consumption of red, processed and visceral meats.

One hundred and ninety-five cases were stroke patients hospitalized in the neurology ward and 195 controls were recruited from patients hospitalized in other wards with no history of cerebrovascular diseases or neurological disorders.

Participants with stroke were older, more likely to be male and less likely to be obese. Individuals in the highest tertile of red meat intake were 119 % more likely to have stroke (OR=2·19; 95 % CI 1·33, 3·60) compared with those in the lowest tertile. After controlling for age, sex and total energy intake, the association between red meat consumption and stroke was strengthened (OR=2·72; 95 % CI 1·53, 4·83). This association remained significant even after further controlling for physical activity and smoking as well as dietary intakes. Additional adjustments for BMI, diabetes, hypertension and hyperlipidaemia did not influence the association significantly (OR=2·51; 95 % CI 1·19, 5·09).

Consumption of red meat was associated with greater odds of having stroke in a group of Iranian adults.

To assess the effect of an unconditional cash transfer (CT) implemented as part of an emergency response to food insecurity during a declared state of emergency.

Pre–post intervention observational study involving two rounds of data collection, i.e. baseline (April 2012) and final survey (September 2012), on the same cohort of ‘poor’ and ‘very poor’ households enrolled by Save the Children in an unconditional CT programme.

Aguié district, Maradi, Niger.

Households with a non-acutely malnourished child aged 6–36 months (n 412).

The study showed that the living standards of ‘poor’ and ‘very poor’ households improved, as indicated by a reduction in poverty-related indicators and an improvement in household food security. Anthropometric outcomes for children aged 6–36 months improved significantly, despite a decline in child health and women’s well-being and autonomy. Risk factors for becoming acutely malnourished post-intervention were being from a very poor household at baseline, starting the lean season with low weight-for-height Z-score (WHZ <−1) and the presence of co-morbidity.

The results of the study are consistent with the published evidence regarding the general impact of CT and suggest it is plausible that giving cash during an emergency can help safeguard living standards of the very poor and poor. While improvements in childhood nutrition status were seen it is not possible to attribute these to the CT programme. However, knowledge of the risk factors for acute malnutrition in a particular setting can be used to influence the design of future CT interventions for which a controlled trial would be recommended if feasible.

Non-pharmacological approaches to the treatment of depression and anxiety are of increasing importance, with emerging evidence supporting a role for lifestyle factors in the development of these disorders. Observational evidence supports a relationship between habitual diet quality and depression. Less is known about the causative effects of diet on mental health outcomes. Therefore a systematic review was undertaken of randomised controlled trials of dietary interventions that used depression and/or anxiety outcomes and sought to identify characteristics of programme success.

A systematic search of the Cochrane, MEDLINE, EMBASE, CINAHL, PubMed and PyscInfo databases was conducted for articles published between April 1971 and May 2014.

Of the 1274 articles identified, seventeen met eligibility criteria and were included. All reported depression outcomes and ten reported anxiety or total mood disturbance. Compared with a control condition, almost half (47 %) of the studies observed significant effects on depression scores in favour of the treatment group. The remaining studies reported a null effect. Effective dietary interventions were based on a single delivery mode, employed a dietitian and were less likely to recommend reducing red meat intake, select leaner meat products or follow a low-cholesterol diet.

Although there was a high level of heterogeneity, we found some evidence for dietary interventions improving depression outcomes. However, as only one trial specifically investigated the impact of a dietary intervention in individuals with clinical depression, appropriately powered trials that examine the effects of dietary improvement on mental health outcomes in those with clinical disorders are required.

To explore changes in urban food environments near schools, as potential contributors to the rising prevalence of overweight and obesity among children.

Addresses of food premises and schools in 1966, 1976, 1986, 1996 and 2006 were geo-coded. For each year, the number and proportion of outlets by category (supermarket/grocery; convenience; fast-food outlet) within 800 m of schools were calculated. The degree of spatial clustering of outlets was assessed using a bivariate K-function analysis. Food outlet categories, school level and school social deprivation quintiles were compared.

Christchurch, New Zealand.

All schools and food outlets at 10-year snapshots from 1966 to 2006.

Between 1966 and 2006, the median number of supermarkets/grocery stores within 800 m of schools decreased from 5 to 1, convenience stores decreased from 2 to 1, and fast-food outlets increased from 1 to 4. The ratio of fast-food outlets to total outlets increased from 0·10 to 0·67. The clustering of fast-food outlets was greatest within 800 m of schools and around the most socially deprived schools. Over the 40-year study period, school food environments in Christchurch can be characterized by increased densities of fast-food outlets within walking distance of schools, especially around the most deprived schools.

Since the 1960s, there have been substantial changes to the food environments around schools which may increasingly facilitate away-from-home food consumption for children and provide easily accessible, cheap energy-dense foods, a recognized contributor to the rise in prevalence of overweight and obesity among young people.

Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight or obesity, in order to identify points for improvement.

An observational checklist was developed to assess goal and implementation intentions and ‘missed opportunities for lifestyle counselling’. Comparisons were made with overall consultation goals set by practice nurses, as measured in a post-visit questionnaire.

Dutch general practice.

One hundred video-taped consultations (2010/2011) between practice nurses and patients with overweight or obesity.

Half of the consultations contained a goal intention, of which the majority aimed to change eating behaviour. Only part of these goal intentions could be considered implementation intentions. It appeared that actions (how elements) were not often included here. Lifestyle change was more often perceived as an overall consultation goal than weight change. Regarding patterns of overall consultation goals, the majority addressed only one lifestyle factor at a time. If practice nurses formulated weight change in their overall consultation goal, they also used goal or implementation intentions, especially for weight change. In a quarter of the consultations, practice nurses did not ask any further questions about weight, nutrition or physical activity to gain insight, which is an important ‘missed opportunity for lifestyle counselling’.

Matching implementation intentions to the broader overall consultation goals of practice nurses would be meaningful, leading to desired goal-directed behaviours and subsequent goal attainment.

Since 2009, Médecins Sans Frontières has implemented a community management of acute malnutrition (CMAM) programme in rural Biraul block, Bihar State, India that has admitted over 10 000 severely malnourished children but has struggled with poor coverage and default rates. With the aim of improving programme outcomes we undertook a qualitative study to understand community perceptions of childhood undernutrition, the CMAM programme and how these affected health-seeking behaviour.

Semi-structured and narrative interviews were undertaken with families of severely malnourished children, non-undernourished children and traditional and allopathic health-care workers. Analysis of transcripts was by qualitative content analysis.

Biraul, Bihar State, India, 2010.

One hundred and fifty people were interviewed in individual or group discussions during fifty-eight interviews.

Undernutrition was not viewed as a disease; instead, local disease concepts were identified that described the clinical spectrum of undernutrition. These concepts informed perception, so caregivers were unlikely to consult health workers if children were ‘only skinny’. Hindu and Muslim priests and other traditional health practitioners were more regularly consulted and perceived as easier to access than allopathic health facilities. Senior family members and village elders had significant influence on the health-seeking behaviour of parents of severely malnourished children.

The results reaffirm how health education and CMAM programmes should encompass local disease concepts, beliefs and motivations to improve awareness that undernutrition is a disease and one that can be treated. CMAM is well accepted by the community; however, programmes must do better to engage communities, including traditional healers, to enable development of a holistic approach within existing social structures.

An important debate in the literature is whether or not higher energy-dense foods are cheaper than less energy-dense foods. The present communication develops and applies an easy statistical test to determine if the relationship between food price and energy density is an artifact of how the data units are constructed (i.e. is it ‘spurious’ or ‘real’?).

After matching data on 4430 different foods from the National Health and Nutrition Examination Survey with corresponding prices from the Center for Nutrition Policy and Promotion’s Food Prices Database, we use a simple regression model to test if the relationship between food price and energy density is ‘real’ or ‘spurious’.

USA.

Total sample size is 4430 observations of consumed foods from 4578 participants from the non-institutionalized US adult population (aged 19 years and over).

Over all 4430 foods, the null hypothesis of a spurious inverse relationship between food price per energy density and energy density is not rejected. When the analysis is broken down by twenty-five food groups, there are only two cases where the inverse relationship is not spurious. In fact, the majority of non-spurious relationships between food price and energy density are positive, not negative.

One of the main arguments put forth regarding the poor diet quality of low-income households is that high energy-dense food is cheaper than lower energy-dense food. We find almost no statistical support for higher energy-dense food being cheaper than low energy-dense food. While economics certainly plays a role in explaining low nutritional quality, more sophisticated economic arguments are required and discussed.

To determine if associations exist between a range of unsaturated fatty acid intakes and mental health outcomes.

Cross-sectional data analysis of the Australian Longitudinal Study on Women’s Health (ALSWH) Young Cohort Survey 3 that included the validated seventy-four-item Dietary Questionnaire for Epidemiological Studies FFQ, validated mental health scales and self-report questions on depression and anxiety.

Australia, 2003.

A nationally representative sample of young Australian women (25–30 years) from ALSWH. The 7635 women with plausible energy intakes (>4·5 but <20·0 MJ/d) were included in the analyses.

Adjusted logistic regression analyses found statistically significant associations between higher intakes of α-linolenic acid and decreased likelihood of depressive symptoms indicated by the ten-item Center for Epidemiological Studies Depression Scale (CESD-10; OR=0·77; 95 % CI 0·60, 0·99; P=0·040) and the Short Form Health Survey (SF-36) mental health subscale (OR=0·73 95 % CI 0·56, 0·96; P=0·024). Furthermore, higher intakes of n-6 fatty acids (OR=0·96, 95 % CI 0·93, 0·99; P=0·019) and linoleic acid (OR=0·96, 95 % CI 0·93, 0·99; P=0·020) were associated with decreased likelihood of self-reported diagnosed anxiety and higher intakes of n-9 fatty acids (OR=1·02, 95 % CI 1·00, 1·04; P=0·041) and oleic acid (OR=1·02, 95 % CI 1·00, 1·05; P=0·046) were associated with increased likelihood of self-reported diagnosed anxiety.

Increased intakes of α-linolenic acid were associated with a reduced likelihood of depressive symptoms, increased intakes of n-6 fatty acids and linoleic acid were associated with a reduced likelihood of self-reported anxiety, and increased intakes of n-9 fatty acids and oleic acid were associated with an increased likelihood of anxiety. Additional studies are needed to further elucidate associations between unsaturated fatty acids and depression and anxiety.

Higher intakes of red and processed meat are associated with poorer health outcomes and negative environmental impacts. Drawing upon a population survey the present paper investigates meat consumption behaviours, exploring perceived impacts for human health, animal welfare and the environment.

Structured self-completion postal survey relating to red and processed meat, capturing data on attitudes, sustainable meat purchasing behaviour, red and processed meat intake, plus sociodemographic characteristics of respondents.

Urban and rural districts of Nottinghamshire, East Midlands, UK, drawn from the electoral register.

UK adults (n 842) aged 18–91 years, 497 females and 345 males, representing a 35·6 % response rate from 2500 randomly selected residents.

Women were significantly more likely (P<0·01) to consume≤1 portion of meat/d compared with men. Females and older respondents (>60 years) were more likely to hold positive attitudes towards animal welfare (P<0·01). Less than a fifth (18·4 %) of the sample agreed that the impact of climate change could be reduced by consuming less meat, dairy products and eggs. Positive attitudes towards animal welfare were associated with consuming less meat and a greater frequency of ‘higher welfare’ meat purchases.

Human health and animal welfare are more common motivations to avoid red and processed meat than environmental sustainability. Policy makers, nutritionists and health professionals need to increase the public’s awareness of the environmental impact of eating red and processed meat. A first step could be to ensure that dietary guidelines integrate the nutritional, animal welfare and environmental components of sustainable diets.

To explore the effect of seasonality on fruit and vegetable availability and prices across three outlet types (farmers’ markets, roadside stands and conventional supermarkets).

Cross-sectional survey of geographically clustered supermarkets, farmers’ markets and roadside stands. Enumerators recorded the availability and lowest price for eleven fruits and eighteen vegetables in each season of 2011.

Price data were collected at retail outlets located in central and eastern North Carolina.

The sample consisted of thirty-three supermarkets, thirty-four farmers’ markets and twenty-three roadside stands.

Outside the local harvest season, the availability of many fruits and vegetables was substantially lower at farmers’ markets and roadside stands compared with supermarkets. Given sufficient availability, some items were significantly cheaper (P<0·05) at direct retail outlets in the peak season (e.g. cantaloupe cost 36·0 % less at roadside stands than supermarkets), while others were significantly more expensive (e.g. carrots cost 137·9 % more at farmers’ markets than supermarkets). Although small samples limited statistical power in many non-peak comparisons, these results also showed some differences by item: two-thirds of fruits were cheaper at one or both direct outlets in the spring and autumn, whereas five of eighteen vegetables cost more at direct retail year-round.

Commonly consumed fruits and vegetables were more widely available at supermarkets in central and eastern North Carolina than at direct retail outlets, in each season. Contingent on item availability, price competitiveness of the direct retail outlets varied by fruit and vegetable. For many items, the outlets compete on price in more than one season.

To explore public health nutritionists’ perceptions of nutrition and its place in community pharmacy (CP) presently and into the future; and to explore perceived opportunities, feasibility and scope of public health nutrition (PHN) interventions in CP, with a focus on maternal and infant nutrition.

Qualitative data were gathered through semi-structured interviews and drew on hermeneutics as the theoretical framework for analysis and interpretation.

Queensland, Australia.

Public health nutritionists, identified through purposive, criterion sampling, were chosen due to (i) their role as potential stakeholders, (ii) their knowledge and emphasis on nutrition and (iii) their practice experience.

Opportunities for PHN action focused primarily on actions relating to early nutrient supplementation in pregnancy and breast-feeding protection and promotion. Opportunities in CP were constrained by practitioners’ perception of (i) conflict between health care and commercial interests in CP, (ii) problematic practices in CP and (iii) values and motivations of practitioners and other stakeholders in the CP sector. Strategies were suggested to improve practices and enhance the setting from a PHN perspective. Participants suggested both collaborative and regulatory approaches to achieve settings-based changes, identifying the need for these to coexist for effective outcomes.

Public health nutritionists suggest that opportunities for PHN action are constrained by perceived conflicted interests and that consumers need to be adequately protected from the influence of commercial interests. PHN action in this setting needs adequate reflection on evidence as well as ethics ensuring that practices are ‘for the good’ of mothers and infants.

To add epidemiological data on the association of adherence to the Mediterranean diet with non-fatal acute myocardial infarction (AMI) in a Southern European population.

Hospital-based case–control study. Conformity to the traditional Mediterranean diet was assessed through a score (i.e. the Mediterranean diet score, MDS) based on nine dietary components (high consumption of vegetables, legumes, fruit and nuts, cereals, and fish and seafood; high ratio of monounsaturated to saturated lipids; low consumption of dairy and meat; and moderate alcohol consumption). The score ranged between 0 (lowest adherence) and 9 (highest adherence). The association of the MDS, or its components, with the risk of AMI was evaluated through multiple logistic regression models, controlling for potential confounding variables.

The study was conducted in the greater Milan area (Italy) between 1995 and 2003.

Seven hundred and sixty patients with a first episode of non-fatal AMI and 682 controls.

High consumption of vegetables and legumes were inversely associated with non-fatal AMI risk. As compared with MDS<4, the OR of non-fatal AMI were 0·85 (95 % CI 0·65, 1·12) for MDS of 4–5 and 0·55 (95 % CI 0·40, 0·75) for MDS≥6, with a trend in risk (P<0·01). Results were consistent in strata of selected risk factors and an apparently stronger association emerged for individuals with a lower BMI.

The Mediterranean diet is inversely associated with the risk of non-fatal AMI in this Southern European population.

Studying eating habits can aid in the design of specific measures that reduce the negative effects of an unhealthy diet on health. In this context, the aim of the present study was to examine the eating habits and food preferences of students and their level of satisfaction with the catering services of the university.

Survey conducted during 2011 using a questionnaire that asked participants abut their sex, age and frequency of use of catering services placed on campus. Participants were also asked about their level of satisfaction with five aspects (hygiene, quality, taste of food, price and convenience of facilities) of the university catering services, what their preferred dishes were and whether they followed a special diet.

Complutense University of Madrid, Spain.

Nine hundred and sixty-four students (381 males; 583 females).

The students used the university food service 2·3 (sd 1·3) times/week. With respect to satisfaction level, 44·1 % gave an average score (3) to the combination of surveyed aspects (hygiene, quality, taste of food, price and comfort of the dining rooms). Regarding food choices, 61·0 % of students preferred pasta dishes, followed by meat (59·1 %) and salads (32·5 %). The least popular dishes were vegetables (16·8 %), fruits (13·6 %), milk products (12·2 %) and legumes (9·8 %). Of the students, 20·1 % followed special diets.

The degree of satisfaction with the university meal service was low and the most common choices of dishes and foods among students were far from the guidelines of the Mediterranean diet. It is necessary to extend policies related to diet to this sector of the population and also to the management and food offer of university canteens.

To examine the characteristics of supporters and opponents of a sugar-sweetened beverage (SSB) tax and to identify pro-tax messages that resonate with the public.

A survey was administered by telephone in February 2013 to assess public opinion about a penny-per-ounce tax on SSB. Support was also examined for SSB consumption reduction and pro-tax messages. Individual characteristics including sociodemographics, political affiliation, SSB consumption behaviours and beliefs were explored as predictors of support using logistic regression.

A representative sample of voters was recruited from a Mid-Atlantic US state.

The sample included 1000 registered voters.

Findings indicate considerable support (50 %) for an SSB tax. Support was stronger among Democrats, those who believe SSB are a major cause of childhood obesity and those who believe childhood obesity warrants a societal intervention. Belief that a tax would be effective in lowering obesity rates was associated with support for the tax and pro-tax messages. Respondents reporting that a health-care provider had recommended they lose weight were less convinced by pro-tax messages. Women, Independents and those concerned about childhood obesity were more convinced by the SSB reduction messages. Overall, the most popular messages focused on the importance of reducing consumption among children without mentioning the tax.

Understanding who supports and opposes SSB tax measures can assist advocates in developing strategies to maximize support for this type of intervention. Messages that focus on the effect of consumption on children may be useful in framing the discussion around SSB tax proposals.

Vegetarian diets may be associated with low prevalence of autoimmune disease, as observed in rural sub-Saharan Africans. Graves’ disease, an autoimmune disorder, is the most common cause of hyperthyroidism. We studied prevalence of hyperthyroidism according to dietary pattern in a population with a high proportion of vegetarians.

Cross-sectional prevalence study. The association between diet and prevalence of hyperthyroidism was examined using multivariate logistic regression analyses controlling for sociodemographic characteristics and salt use.

The Adventist Health Study-2 conducted in the USA and Canada.

Church members (n 65 981) provided demographic, dietary, lifestyle and medical history data by questionnaire.

The prevalence of self-reported hyperthyroidism was 0·9 %. Male gender (OR=0·32; 95 % CI 0·26, 0·41) and moderate or high income (OR=0·67; 95 % CI 0·52, 0·88 and OR=0·73; 95 % CI 0·58, 0·91, respectively) protected against hyperthyroidism, while obesity and prevalent CVD were associated with increased risk (OR=1·25; 95 % CI 1·02, 1·54 and OR=1·92; 95 % CI 1·53, 2·42, respectively). Vegan, lacto-ovo and pesco vegetarian diets were associated with lower risk compared with omnivorous diets (OR=0·49; 95 % CI 0·33, OR=0·72, 0·65; 95 % CI 0·53, 0·81 and OR=0·74; 95 % CI 0·56, 1·00, respectively).

Exclusion of all animal foods was associated with half the prevalence of hyperthyroidism compared with omnivorous diets. Lacto-ovo and pesco vegetarian diets were associated with intermediate protection. Further study of potential mechanisms is warranted.