title: Diet and 20-year chronic obstructive pulmonary disease mortality in middle-aged men from three European countries.
abstract: OBJECTIVE
  To investigate the relation of baseline antioxidant, fruit, vegetable and fish intake with 20 y chronic obstructive pulmonary disease (COPD) mortality in middle-aged men from three European countries.
  
  
  METHODS
  Prospective study (1970-1990).
  
  
  METHODS
  Five population-based cohorts of middle-aged men from Finland, Italy and The Netherlands.
  
  
  METHODS
  A total of 2917 men aged 50-69 y at baseline.
  
  
  METHODS
  Baseline information on diet was collected using the cross-check dietary history method. After 20 y of follow-up the underlying cause of death of those who died was established centrally. Survival analyses were performed using the Cox Proportional Hazards Model.
  
  
  RESULTS
  After adjustment for age, smoking and country, we observed an inverse trend (P-trend <0.05) of 20 y COPD mortality across tertiles of fruit and vitamin E intake. No trend was observed for vegetables, fish, vitamin C and beta-carotene. When modelled continuously, a 100 g increase in fruit intake was associated with a 24% lower COPD mortality risk (RR=0.76, 95% CI=0.60-0.92). For vitamin E intake (per 5 mg) the RR was 0.77 (95% CI=0.55-1.06), after adjustment for age, smoking and country. Additional adjustment for body mass index, total energy intake and alcohol consumption reduced the RR to 0.86 (95% CI=0.69-1.07, P=0.12) for fruit and 0.93 (95% CI=0.65-1.33) for vitamin E.
  
  
  CONCLUSIONS
  Our results suggest a protective effect of fruit and possibly vitamin E intake against COPD. No effect was observed for intake of vitamin C, beta-carotene, vegetables and fish.
authors.affiliation: Department of Chronic Disease Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: I C
authors.initials: IC
authors.lastname: Walda
authors.forename: C
authors.initials: C
authors.lastname: Tabak
authors.forename: H A
authors.initials: HA
authors.lastname: Smit
authors.forename: L
authors.initials: L
authors.lastname: Räsänen
authors.forename: F
authors.initials: F
authors.lastname: Fidanza
authors.forename: A
authors.initials: A
authors.lastname: Menotti
authors.forename: A
authors.initials: A
authors.lastname: Nissinen
authors.forename: E J M
authors.initials: EJ
authors.lastname: Feskens
authors.forename: D
authors.initials: D
authors.lastname: Kromhout
mesh_terms: D000328:Adult; D000975:Antioxidants / Q000008:administration & dosage*; D002423:Cause of Death; D015331:Cohort Studies; D004032:Diet; D004034:Diet Surveys; D002149:Energy Intake; D005387:Finland / Q000453:epidemiology; D005638:Fruit; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality*; D017747:Seafood; D012907:Smoking; D016019:Survival Analysis; D014675:Vegetables; D014810:Vitamin E / Q000008:administration & dosage
chemical_list: D000975:Antioxidants; D014810:Vitamin E