Diet and 20-year chronic obstructive pulmonary disease mortality in middle-aged men from three european countries

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.Design: Prospective study (11970-1990).Setting: Five population-based cohorts of middle-aged men from Finland, Italy and The Netherlands.Subjects: 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 ß-carotene. When modelled continuously, a 100 g increase in fruit intake was associated with a 24% lower COPD mortality risk (RR = 0.76, 95% Cl = 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, ß-carotene, vegetables and fish.