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

Eur J Clin Nutr. 2002 Jul;56(7):638-43. doi: 10.1038/sj.ejcn.1601370.


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 (1970-1990).

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 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.

MeSH terms

  • Adult
  • Antioxidants / administration & dosage*
  • Cause of Death
  • Cohort Studies
  • Diet
  • Diet Surveys
  • Energy Intake
  • Finland / epidemiology
  • Fruit*
  • Humans
  • Italy / epidemiology
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Proportional Hazards Models
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / mortality*
  • Seafood*
  • Smoking
  • Survival Analysis
  • Vegetables*
  • Vitamin E / administration & dosage


  • Antioxidants
  • Vitamin E