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Vegans avoid consuming animal flesh, animal byproducts, and foods containing ingredients of animal origin. This includes: Key TJ, Appleby PN, Spencer EA, Travis RC, Roddam AW, Allen NE. Mortality in British vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). Am J Clin Nutr. 2009;89:1613S–1619S. Smith MJ, Walline JJ. Controlling myopia progression in children and adolescents. Adolesc Health Med Ther. 2015;6:133–140. Orlich MJ, Singh PN, Sabate J, Fan J, Sveen L, Bennett H, et al. Vegetarian dietary patterns and the risk of colorectal cancers. JAMA Intern Med. 2015;175:767–76. Melina V, Craig W, Levin S. Position of the academy of nutrition and dietetics: vegetarian diets. J Acad Nutr Diet. 2016;116:1970–80.

Appleby PN, Crowe FL, Bradbury KE, Travis RC, Key TJ. Mortality in vegetarians and comparable nonvegetarians in the United Kingdom. Am J Clin Nutr. 2016;103:218–30. The strengths of the study are that the data were collected prospectively in a well-designed, established cohort study. Much effort has gone into validating the dietary and physical activity questionnaires [ 20– 23]. The prospective design minimized recall bias. Study results were strengthened due to measurement of several well known confounders. After accounting for potential confounding, the associations remained strong. Butler TL, Fraser GE, Beeson WL, et al. Cohort profile: the Adventist Health Study-2 (AHS-2). Int J Epidemiol. 2008;37:260–5. Melina, V., C. Winston & S. Levin (2016): Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. Journal of the Academy of Nutrition and Dietetics 116, no. 12 (December 2016): pp. 1970–80.Huang J, Wen D, Wang Q, et al. Efficacy comparison of 16 interventions for myopia control in children: a network meta-analysis. Ophthalmology. 2016;123(4):697–708. Bellavia A, Stilling F, Wolk A. High red meat intake and all-cause cardiovascular and cancer mortality: is the risk modified by fruit and vegetable intake? Am J Clin Nutr. 2016;104:1137–43. Dinu, M., R. Abbate, G. F. Gensini, et al. (2017): Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr. 57, p.3640–3649

Discussion: Myopia was common in this large and diverse Southern Californian pediatric cohort. The prevalence of myopia increases with age. Asian children are at highest risk for myopia. Exercise is associated with a lower rate of myopia and represents an important potentially modifiable risk factor that may be a target for future public health efforts. Conclusions These non-randomized data across U.S. clinical practices show high and stable vaccine effectiveness of Ad26.COV2.S over time before the Delta variant emerged to when the Delta variant was dominant. Competing Interest Statement Varma R, Tarczy-Hornoch K, Jiang X. Visual impairment in preschool children in the United States: demographic and geographic variations from 2015 to 2060. JAMA Ophthalmol. 2017;135(6):610–616. These results are congruent with our earlier prevalence study of determinants of type 2 diabetes [ 14]. In this study, there appeared to be an incremental protection as dietary pattern moved from non-vegetarian to semi-vegetarian to pesco vegetarian to lacto ovo vegetarian to vegan [ 14]. In the current study the vegan diet appeared to afford the greatest protection against the development of diabetes, however, confidence limits of the vegan and lacto ovo and semi-vegetarian diets largely overlapped, indicating no significant differences between the dietary patterns. Furthermore, the results for vegans should be interpreted with care, as there were only a very small number of vegans who developed diabetes. Wu LJ, You QS, Duan JL, et al. Prevalence and associated factors of myopia in high-school students in Beijing. PLoS One. 2015;10(3):e0120764.

Some selection bias is present due to non-response to the follow-up questionnaire. The enrollment questionnaire was lengthy and may have discouraged completion of the survey. Dietary measurement error is inevitable and may result in misclassification. Measurement errors may be introduced by under or over reporting of foods eaten. Random error in measuring intake and dietary change attenuate the associations. The vegetarian diet was positively associated with some lifestyle related factors and inversely associated with others. It is possible that some residual confounding has remained after adjustment because of inaccurate measurements.

Leitzmann, C. & M. Keller (2010): Vegetarische Ernährung. Stuttgart: Verlag Eugen Ulmer, 2. Ed., p. 37-38Refractive error measurements were collected from KPSC electronic health records and used to calculate each refraction’s spherical equivalent. Patients could have multiple refractions recorded in their electronic chart for any given visit including autorefraction, cycloplegic refraction, and/or subjective refractions. The different refractions are not coded electronically in a way that can be differentiated upon en masse data extraction for a study. The last refractive measurement for any given visit was used for analysis for this study – this refraction is what was used for dispensing corrective glasses (when clinically indicated) and was typically the finalized refraction after subjective refinement. Data were collected for the right and left eyes separately with the right eye measurements being used for analysis. Myopia was defined in this study as refractive error ≤−1.0 D and high myopia was defined as refractive error ≤−6.0 D. This definition for myopia was used since lower levels of myopia are often left uncorrected and not deemed clinically significant by clinicians, and also because the frequent use of subjective refraction may overestimate the degree of myopia in children. Unless otherwise described, all variables examined in the study were those on the date of the refractive error measurement for which the patient was myopic or the latest refractive error ever measured in the study period. For the purposes of the cross-sectional study, this date was the index date. Huang, T., B. Yang, J. Zheng, et al. (2012): Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review. Ann. Nutr. Metab. 60, p.233–240 Harvard T. H. Chan (2018): Fats and Cholesterol, Available at: https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-and-cholesterol/ [11.06.2018]

Burlingame B, Dernini S. Sustainable diets and biodiversity: directions and solutions for policy, research and action. Proceedings of the International Scientific Symposium, Biodiversity and Sustainable Diets United Against Hunger. Rome, Italy: FAO Headquarters; 2010. p. 83. Dr. Schneeweiss (ORCID# 0000-0003-2575-467X) is participating in investigator-initiated grants to the Brigham and Women's Hospital from Boehringer Ingelheim unrelated to the topic of this study. He is a consultant to Aetion Inc. of which he owns equity. His interests were declared, reviewed, and approved by the Brigham and Women's Hospital in accordance with their institutional compliance policies. Funding Statement Chua J, Wong TY. Myopia-the silent epidemic that should not be ignored. JAMA Ophthalmol. 2016;134(12):1363–1364.The vegan food plate offers a simple guide to healthy vegan nutrition. The composition of the vegan plate corresponds to current scientific knowledge regarding the health effects of what we eat and drink on a vegan diet. [7] Harvard T. H. Chan (2018): Healthy Eating Plate & Healthy Eating Pyramid. Available at: https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/ [11.06.2018] What to avoid on a vegan diet

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