Flavonoids have been suggested to protect against chronic lung disease. We studied intake of catechins, flavonols, and flavones in relation to pulmonary function and COPD symptoms in 13,651 adults from three Dutch cities examined from 1994 to 1997. Dietary intake was estimated using a food frequency questionnaire, and flavonoid intake was calculated using specific food composition tables. Pulmonary function (FEV1) was determined by spirometry and COPD symptoms by questionnaire. Associations were presented for the fifth versus the first quintile of intake (Q5-Q1), adjusted for age, height (for FEV1 only), sex, smoking, BMI, and energy intake. Smoking was strongly associated with COPD, independent of dietary effects. Average catechin, flavonol, and flavone intake was 58 mg/d (SD = 46) with tea and apples as main sources. Total catechin, flavonol, and flavone intake was positively associated with FEV1 (beta(Q5-Q1) = 44 ml, 95% CI = 18-69) and inversely associated with chronic cough (OR(Q5-Q1) = 0.80, 95% CI = 0.66-0.97) and breathlessness (OR(Q5-Q1) = 0.74, 95% CI = 0.58- 0.94), but not chronic phlegm. Catechin intake was independently associated with FEV1 (beta(Q5-Q1) = 130 ml, 95% CI = 101-159) and all three COPD symptoms (OR(Q5-Q1) = 0.60-0.72, p < 0.001). Flavonol and flavone intake was independently associated with chronic cough only. Solid fruit, but not tea, intake was beneficially associated with COPD. Our results suggest a beneficial effect of a high intake of catechins and solid fruits against COPD.

Our results suggest independent beneficial effects of fruits, whole grains and alcohol on COPD that are largely additive and cannot be explained by smoking habits.

Results-FEV was positively associated with intake of vitamin E in Finland, with intake of fruit in Italy, and with intake of -carotene in the Netherlands. In all three countries men with intakes of both fruit and vegetables above the median had a higher FEV than those with a low intake of both foods. The diVerence in FEV ranged from 110 to 169 ml before and from 53 to 118 ml after energy adjustment. DiVerences in FEV for intake of three antioxidants (vitamins C and E and -carotene) above versus below the median ranged from 61 to 181 ml before and from -35 to 58 ml after energy adjustment. Intake of fish was not associated with FEV. Conclusions-In three European countries a high intake of fruit and vegetables was positively associated with pulmonary function. A high intake of all three antioxidants tended to be positively associated with pulmonary function before, but not after, adjustment for energy intake. Associations of individual antioxidants with pulmonary function were not consistent across countries.

Background: The rise in the prevalence of asthma in western societies may be related to changed dietary habits. Epidemiological studies in children have shown inverse associations of asthma related outcomes with intake of fruits, vegetables, dairy and whole grain products, and fish. In contrast to most previous studies, we used both questionnaire and clinical data to define asthma. Methods: Intake of the abovementioned foods was studied in relation to asthma in 598 Dutch children aged 8-13 years. Dietary intake was estimated using a parent completed semi-quantitative food frequency questionnaire. Current wheeze and current asthma were defined based on questionnaire data. More complex end points were defined using information on bronchial hyperresponsiveness (BHR) and atopic sensitisation as well. Linear associations were studied using logistic regression analysis and odds ratios presented for the highest versus the lowest tertile of intake. In the final models, adjustments were made for maternal educational level, foreign descent, and total energy intake. Results: The intake of whole grain products and of fish was inversely associated with asthma. Adjusted odds ratios for the independent associations with whole grains and fish were 0.46 (95% CI 0.19 to 1.10) and 0.34 (95% CI 0.13 to 0.85) for current asthma and 0.28 (95% CI 0.08 to 0.99) and 0.12 (95% CI 0.02 to 0.66) for atopic asthma with BHR. Similar results were observed for current wheeze and atopic wheeze with BHR. Intake of (citrus) fruits, vegetables, and dairy products showed no clear associations with asthma end points. Conclusions: Our findings suggest that a high intake of whole grain products and fish may have a protective effect against asthma in children.

The epidemiological evidence for a relationship between diet and indicators of asthma and chronic obstructive pulmonary disease (COPD) is evaluated. The review focuses on the intake of Na,n−3 fatty acids, and antioxidant vitamins as well as fruit and vegetables. Experimental studies suggest that a high-Na diet has a small adverse effect on airway reactivity in asthma patients. However, observational studies provide no clear evidence that high Na intake has adverse effects on airway reactivity or asthma symptoms in open populations.n−3 Polyunsaturated fatty acids, which are present in fish oils, are metabolized into less broncho-constricting and inflammatory mediators thann−6 polyunsaturated fatty acids. Studies in the general adult population suggest that a high fish intake has a beneficial effect on lung function, but the relationship with respiratory symptoms and clinically-manifest asthma or COPD is less evident. Also, experimental studies in asthma patients have not demonstrated an improvement in asthma severity after supplementation with fish oil. Several studies showed a beneficial association between fruit and vegetable intake and lung function, but the relationship with respiratory symptoms and the clinically-manifest disease was less convincing. A similar pattern was found for vitamin C in relation to indicators of asthma and COPD, but there are still conflicting results with respect to vitamin E and β-carotene. In conclusion, the epidemiological evidence for a beneficial effect on indicators of asthma and COPD of eating fish, fruit and vegetables is increasing. However, the effectiveness of dietary supplementation in open-population samples is often not demonstrated. Several unresolved questions are raised, which should be addressed in future studies on the relationship between diet and respiratory disease.

In susceptible infants, the risk to develop allergic symptoms, but not the risk of sensitization, was modified by intake of n-3 long chain polyunsaturated fatty acids through breast milk.

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 b-carotene. When modelled continuously, a 100 g increase in fruit intake was associated with a 24% lower COPD mortality risk (RR ¼ 0.76, 95% CI ¼ 0.60 -0.92). For vitamin E intake (per 5 mg) the RR was 0.77 (95% CI ¼ 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 ¼ 0.69 -1.07, P ¼ 0.12) for fruit and 0.93 (95% CI ¼ 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, b-carotene, vegetables and fish.

Alcohol consumption shows a U-shaped relation with all-cause and cardiovascular mortality. To determine whether a similar relation exists between alcohol and chronic obstructive pulmonary disease mortality, we analyzed data on alcohol consumption in 1970 and 20-year mortality from chronic obstructive pulmonary disease among 2,953 middle-aged men from Finland, Italy, and the Netherlands. We also studied alcohol consumption in relation to pulmonary function (FEV1 or FEV0.75) at baseline. We used regression models adjusted for age, height (for pulmonary function only), body mass index, smoking habits, energy intake, and country. A smoothed spline-plot showed a U-shaped relation between alcohol and chronic obstructive pulmonary disease mortality. Compared with non-drinkers and occasional drinkers, the relative risk of chronic obstructive pulmonary disease mortality was 0.60 (95% CI = 0.33-1.09) in light drinkers (> 1 drink per week, < or = 3 drinks per day) and 1.25 (95% CI = 0.47-3.31) in moderate-to-heavy drinkers. Pulmonary function was lower in non-drinkers compared with occasional and light drinkers in Finland (75 ml, 95% CI = -2 to 151) and the Netherlands (93 ml, 95% CI = 0-186) and lower in very heavy (> 12 drinks per day) compared with moderate-to-heavy drinkers in Italy (99 ml, 95% CI = 9-189). In conclusion, we observed a U-shaped curve between alcohol consumption and 20-year chronic obstructive pulmonary disease mortality in middle-aged men that was supported by cross-sectional data on alcohol and pulmonary function.