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In addition, all the studies adjusted extensively for possible confounding by known risk factors, including smoking. In the large population-based Cyclopamine Atherosclerosis Risk in Communities Study comprising 11?897 US men and women aged 44�C66 years, higher total dietary fibre intake was cross-sectionally associated with better lung function (FEV1, forced vital capacity (FVC) and FEV1/FVC ratio).[15] Notably, people in the highest quintile of total dietary fibre intake (median 25.0?g/day) had an adjusted 60?mL higher FEV1 compared with people in the lowest quintile (median 10.2?g/day). In addition, higher total dietary fibre intake was associated with lower odds ratios for COPD (odds ratio 0.85, 95% confidence interval 0.68�C1.05). COPD was defined as prebronchodilator FEV1/FVC? of predicted and/or self-reported persisted cough and production of phlegm on most days for at least 3 consecutive months of the year for 2 or more years. Similar data were obtained when investigated for fibre from cereals and fibre from fruit, but not for fibre from vegetables. Another study by Hirayama et?al.[16] compared 278 Japanese COPD patients (mean FEV1 57% of predicted) and 340 community-based non-COPD controls and found that the mean vegetable and fruit intakes of http://www.selleckchem.com/products/BI-2536.html COPD patients were significantly lower. The authors subsequently applied logistic regression analyses to estimate the odds of having COPD across quartiles of nutrient intakes. They found that people who consumed ��16.1?g total dietary fibre per day had lower odds of having COPD compared with those who consumed BML-190 ratio 0.49, 95% confidence interval 0.26�C0.94). Upon stratification into soluble and insoluble fibre intake, the authors found a similar association for insoluble but not soluble fibre. Although the earlier referenced data from the Atherosclerosis Risk in Communities Study and the Japanese study may suggest a role for dietary fibre in COPD aetiology, their cross-sectional natures preclude the drawing of any causal inferences. Two other studies, however, applied a prospective design and showed remarkably consistent results. First, in a 5-year prospective population-based cohort of 63?257 middle-aged men and women residing in China and Singapore,[17] higher intake of non-starch polysaccharides was associated with a lower incidence of ��COPD symptoms�� (defined as cough and phlegm, both shorter and longer than 3 months). Interestingly, whereas fruit and vitamin C intakes were also associated with lower incident COPD symptoms, these associations disappeared after further adjustment for dietary fibre intake. This suggests that dietary fibre intake may be at least partly responsible for these associations. However, in epidemiological studies, it remains difficult to disentangle associations with dietary fibre intake from for example anti-oxidant intake when they are consumed simultaneously.