title: Fruit and fish consumption: a possible explanation for population differences in COPD mortality (The Seven Countries Study).
abstract: OBJECTIVE
  To investigate whether average intake of antioxidants, fruits, vegetables and fish may help to explain international differences in chronic obstructive pulmonary disease (COPD) mortality.
  
  
  METHODS
  Ecological analysis using information on baseline diet and the 25-year COPD mortality rate in the 16 cohorts of the Seven Countries Study.
  
  
  METHODS
  Population-based cohorts.
  
  
  METHODS
  Men aged 40-59 years at baseline.
  
  
  METHODS
  Dietary information was collected at baseline in small random samples of each cohort. In 1987 the reported foods were bought locally and analysed chemically. After 25 years of follow-up the underlying cause of death of those who died was established centrally. COPD mortality rate ratios were calculated, for a change equivalent to 10% of the overall mean consumption of a dietary factor.
  
  
  RESULTS
  We observed independent inverse associations between 25-year COPD mortality and baseline consumption of fruits (rate ratio 0.49; 95% confidence interval 0.36-0.67) and fish (rate ratio, 0.97; 95% confidence interval 0.93-1.00), after adjustment for potential confounders. COPD mortality showed no statistically significant association with intake of antioxidants or vegetables. Fruit and fish consumption together explained about 67% of the variance in the COPD mortality rates of the cohorts.
  
  
  CONCLUSIONS
  Fruit and fish consumption may partly explain population differences in COPD mortality. This is in accordance with suggestions for a relationship between fruit and fish consumption and COPD observed in studies in individuals.
authors.affiliation: Department of Chronic Diseases and Environmental Epidemiology, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Tabak
authors.forename: E J
authors.initials: EJ
authors.lastname: Feskens
authors.forename: D
authors.initials: D
authors.lastname: Heederik
authors.forename: D
authors.initials: D
authors.lastname: Kromhout
authors.forename: A
authors.initials: A
authors.lastname: Menotti
authors.forename: H W
authors.initials: HW
authors.lastname: Blackburn
mesh_terms: D000328:Adult; D000818:Animals; D000975:Antioxidants; D015331:Cohort Studies; D004032:Diet; D005387:Finland; D005399:Fishes; D005638:Fruit; D006115:Greece; D006801:Humans; D007558:Italy; D007564:Japan; D008173:Lung Diseases, Obstructive / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D014481:United States; D015022:Yugoslavia
chemical_list: D000975:Antioxidants