Ryoko Katagiri

Purpose: To optimise diets that are more nutritious, have lower diet-related greenhouse gas emissions (GHGE) based on cradle-to-pre-retail impact, and remain affordable for Japanese adults of different age groups. Methods: Eight-day dietary records collected from younger (aged 18–49 years; 711 males and 734 females) and older (aged 50–74 years; 565 males and 605 females) Japanese adults were analysed. For each sex–age group, optimised diets were derived under three optimisation models using Data Envelopment Analysis: (i) MaxNRF: maximisation of diet quality score (Nutrient Rich Food Index [NRF] 9.3); (ii) MinGHGE: minimisation of GHGE; and (iii) OPT2G: combination of both objectives. All models included a monetary cost constraint (105% of observed). The proportions of participants having inadequate nutrient intakes, based on the Japanese Dietary Reference Intakes, were compared between observed diets and three optimised diets. Results: All optimised diets showed NRF9.3 scores 13.5–35.9% higher than those observed in all sex-age groups. GHGE decreased by 12.6–32.7% in the MinGHGE and OPT2G only. Differences between the optimised and observed diets in NRF9.3 score and GHGE were generally larger in younger than in older adults. All optimised diets showed lower or similar prevalences of inadequate nutrient intake compared with observed values. However, in younger males, optimised diets with MinGHGE had less favourable macronutrient distributions and higher inadequacies of vitamins A, C, and riboflavin than observed. Conclusion: Optimised diets showed better nutrient adequacy and lower GHGE across all sex-age groups, although specific nutrient shortfalls warrant attention when minimising GHGE in younger males.

Supplementary Figure 3: Forest plots of the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) generated by combining cohort-specific HRs for the association between reproductive factors and the overall risk of thyroid cancer in the Asia Cohort Consortium. A - Forest plot for the pooled HRs and CIs for breastfeeding status and thyroid cancer risk, overall B - Forest plot for the pooled HRs and CIs for postmenopausal status and thyroid cancer risk, overall C - Forest plot for the pooled HRs and CIs for age at menopause and thyroid cancer risk, overall

Supplementary Methods 1: Details on the development of the Asia Cohort Consortium reproductive factor working group protocol

Supplementary Figure 4: Forest plots of the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) generated by combining cohort-specific HRs for the association between reproductive factors and the overall risk of thyroid cancer in the Asia Cohort Consortium. A - Forest plot for the pooled HRs and CIs for oral contraceptive use and thyroid cancer risk, overall B - Forest plot for the pooled HRs and CIs for hormone replace therapy use and thyroid cancer risk, overall

Supplementary Table 2: Distribution of total cases according to histology according to participating cohorts

Supplementary Figure 5: Forest plot of stratified analysis between number of children/deliveries and thyroid cancer risk by birth years in the Asia Cohort Consortium. The Pooled Hazard Ratios (HRs) with 95% Confidence intervals (CIs) were generated by combining cohort-specific HRs. Models were adjusted for smoking status, alcohol drinking status and Body mass index. a Significant (p-value <0.05) trend across categories of the reproductive factor. b Significant (p-value <0.05) for interaction indicating a modifying effect on the association between the reproductive factor and thyroid cancer risk.

Supplementary Figure 1: Forest plots of the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) generated by combining cohort-specific HRs for the association between reproductive factors and the overall risk of thyroid cancer in the Asia Cohort Consortium. A - Forest plot for the pooled HRs and CIs for age at menarche and thyroid cancer risk, overall B - Forest plot for the pooled HRs and CIs for age at first delivery and thyroid cancer risk, overall

Supplementary Table 1: Study population and exclusion criteria by cohorts as established by the ACC reproductive factor working group

Supplementary Table 3: Pooled relative risks for recategorized age at menarche and age at menopause & incident thyroid cancer risk, Overall and papillary type

Supplementary Figure 2: Forest plots of the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) generated by combining cohort-specific HRs for the association between reproductive factors and the overall risk of thyroid cancer in the Asia Cohort Consortium. A - Forest plot for the pooled HRs and CIs for parity status and thyroid cancer risk, overall B - Forest plot for the pooled HRs and CIs for number of children/deliveries and thyroid cancer risk, overall C - Forest plot for the pooled HRs and CIs for recategorized number of children/deliveries and thyroid cancer risk, overall