Fruit and fish consumption: a possible explanation for population differences in COPD mortality (The Seven Countries Study)

Eur J Clin Nutr. 1998 Nov;52(11):819-25. doi: 10.1038/sj.ejcn.1600653.


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.

Design: Ecological analysis using information on baseline diet and the 25-year COPD mortality rate in the 16 cohorts of the Seven Countries Study.

Setting: Population-based cohorts.

Subjects: 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.

MeSH terms

  • Adult
  • Animals
  • Antioxidants*
  • Cohort Studies
  • Diet*
  • Finland
  • Fishes*
  • Fruit*
  • Greece
  • Humans
  • Italy
  • Japan
  • Lung Diseases, Obstructive / mortality*
  • Male
  • Middle Aged
  • Netherlands
  • United States
  • Yugoslavia


  • Antioxidants