The assessment of Chronic Obstructive Pulmonary Disease (COPD) and its relation to the Mediterranean diet in Moroccan adults - BOLD study
Main Article Content
Abstract
Objective: The protective effect of the Mediterranean diet (MD) is known for several diseases, but the evidence in low- and middle-income countries was still missing. This article assesses the impact of MD and its components on Chronic Obstructive Pulmonary Disease (COPD) among Moroccan adults.
Methods: in population-based cross-sectional study, A total of 744 adults with acceptable spirometry according to the GOLD guidelines were randomly selected from a sample frame, of Moroccan adults lived in the areas of the Saïs district-Fez city. Dietary data were collected through a validated food frequency questionnaire. Mediterranean Diet Score (MDS) was used to assess Adherence to the Mediterranean food model, A value of 0 or 1 has been assigned to each of the eight indicated food components according to their beneficial or deleterious effect on health.
Results: Although no significant associations were found between COPD and the overall MD. score, associations were found between some of the MD components and COPD when stratifying for overall MDS adherence level (low, middle, high adherence). For the high adherence group, the high consumption of cereals, fruits and nuts were inversely associated with COPD risk with OR = 0.64; 95% CI = 0.26-0.89, and OR= 0.67; 95% CI = 0.44-0.96, respectively. The high consumption of meats and dairy products was positively associated with the risk of COPD, with OR = 1.37; 95% CI = 1.22-2.87, and OR= 1.83; 95% CI = 1.21-2.76, respectively.
Conclusion: The results of this study confirmed previous results showing significant associations of COPD risk with some components of MDS. Extensive studies are needed to explore MDS components better and suggest more effective interventions to maintain healthy eating habits and reduce COPD risk.
Article Details
How to Cite
BENSLIMANE, Abdelilah et al.
The assessment of Chronic Obstructive Pulmonary Disease (COPD) and its relation to the Mediterranean diet in Moroccan adults - BOLD study.
Medical Research Archives, [S.l.], v. 10, n. 7, july 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2882>. Date accessed: 20 apr. 2024.
doi: https://doi.org/10.18103/mra.v10i7.2882.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. RGPH 2014 | Téléchargements | Site institutionnel du Haut-Commissariat au Plan du Royaume du Maroc. Accessed June 9, 2020. https://www.hcp.ma/downloads/RGPH-2014_t17441.html
2. El Rhazi K, Nejjari C, Romaguera D, et al. Adherence to a Mediterranean diet in Morocco and its correlates: cross-sectional analysis of a sample of the adult Moroccan population. BMC Public Health. 2012;12:345. doi:10.1186/1471-2458-12-345
3. Morocco country nutrition profile. Global Nutrition Report. Published 17:02:03.175006+00:00. Accessed May 27, 2019. https://globalnutritionreport.org/nutrition-profiles/africa/northern-africa/morocco/
4. Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532-555. doi:10.1164/rccm.200703-456SO
5. El Rhazi K, Nejjari C, BenJelloun MC, El Biaze M, Attassi M, Garcia-Larsen V. Prevalence of chronic obstructive pulmonary disease in Fez, Morocco: results from the BOLD study. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2016;20(1):136-141. doi:10.5588/ijtld.15.0029
6. Duffy S, Barnett S, Civic B, Criner GJ, A James Mamary MD, others. Risk of death by comorbidity prompting rehospitalization following the initial COPD hospitalization. Chronic Obstr Pulm Dis J COPD Found. 2015;2(1):17-22.
7. Scoditti E, Massaro M, Garbarino S, Toraldo DM. Role of Diet in Chronic Obstructive Pulmonary Disease Prevention and Treatment. Nutrients. 2019;11(6). doi:10.3390/nu11061357
8. Fischer A, Johansson I, Blomberg A, Sundström B. Adherence to a Mediterranean-like Diet as a Protective Factor Against COPD: A Nested Case-Control Study. COPD. 2019;16(3-4):272-277. doi:10.1080/15412555.2019.1634039
9. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348(26):2599-2608. doi:10.1056/NEJMoa025039
10. Kaluza J, Harris HR, Linden A, Wolk A. Long-term consumption of fruits and vegetables and risk of chronic obstructive pulmonary disease: a prospective cohort study of women. Int J Epidemiol. 2018;47(6):1897-1909. doi:10.1093/ije/dyy178
11. Kaluza J, Harris H, Linden A, Wolk A. Long-term unprocessed and processed red meat consumption and risk of chronic obstructive pulmonary disease: a prospective cohort study of women. Eur J Nutr. 2019;58(2):665-672. doi:10.1007/s00394-018-1658-5
12. Gutiérrez-Carrasquilla L, Sánchez E, Hernández M, et al. Effects of Mediterranean Diet and Physical Activity on Pulmonary Function: A Cross-Sectional Analysis in the ILERVAS Project. Nutrients. 2019;11(2). doi:10.3390/nu11020329
13. El Rhazi K, Nejjari C, Zidouh A, Bakkali R, Berraho M, Barberger Gateau P. Prevalence of obesity and associated sociodemographic and lifestyle factors in Morocco. Public Health Nutr. 2011;14(1):160-167. doi:10.1017/S1368980010001825
14. Buist AS, Vollmer WM, Sullivan SD, et al. The Burden of Obstructive Lung Disease Initiative (BOLD): rationale and design. COPD. 2005;2(2):277-283.
15. World Health Organization. Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation, Geneva, 8-11 December 2008. World Health Organization; 2011.
16. Enright P, Vollmer WM, Lamprecht B, et al. Quality of spirometry tests performed by 9893 adults in 14 countries: the BOLD Study. Respir Med. 2011;105(10):1507-1515.
17. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med. 2017;195(5):557-582. doi:10.1164/rccm.201701-0218PP
18. El Kinany K, Garcia-Larsen V, Khalis M, et al. Adaptation and validation of a food frequency questionnaire (FFQ) to assess dietary intake in Moroccan adults. Nutr J. 2018;17(1):61. doi:10.1186/s12937-018-0368-4
19. Khalis M, Garcia-Larsen V, Charaka H, et al. Update of the Moroccan food composition tables: Towards a more reliable tool for nutrition research. J Food Compos Anal. 2020;87:103397. doi:10.1016/j.jfca.2019.103397
20. Thiébaut A, Kesse E, Com-Nougué C, Clavel-Chapelon F, Bénichou J. Ajustement sur l’apport énergétique dans l’évaluation des facteurs de risque alimentaires. Rev DÉpidémiologie Santé Publique. 2004;52(6):539-557. doi:10.1016/S0398-7620(04)99093-1
21. Bach-Faig A, Berry EM, Lairon D, et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011;14(12A):2274-2284. doi:10.1017/S1368980011002515
22. Serra-Majem L, Tomaino L, Dernini S, et al. Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns. Int J Environ Res Public Health. 2020;17(23):8758. doi:10.3390/ijerph17238758
23. Martín-Luján F, Catalin RE, Salamanca-González P, et al. A clinical trial to evaluate the effect of the Mediterranean diet on smokers lung function. NPJ Prim Care Respir Med. 2019;29(1):40. doi:10.1038/s41533-019-0153-7
24. Papanikolaou Y, Fulgoni VL. Certain Grain Foods Can Be Meaningful Contributors to Nutrient Density in the Diets of U.S. Children and Adolescents: Data from the National Health and Nutrition Examination Survey, 2009-2012. Nutrients. 2017;9(2). doi:10.3390/nu9020160
25. Veronese N, Solmi M, Caruso MG, et al. Dietary fiber and health outcomes: an umbrella review of systematic reviews and meta-analyses. Am J Clin Nutr. 2018;107(3):436-444. doi:10.1093/ajcn/nqx082
26. Kan H, Stevens J, Heiss G, Rose KM, London SJ. Dietary fiber, lung function, and chronic obstructive pulmonary disease in the atherosclerosis risk in communities study. Am J Epidemiol. 2008;167(5):570-578. doi:10.1093/aje/kwm343
27. Varraso R, Willett WC, Camargo CA. Prospective Study of Dietary Fiber and Risk of Chronic Obstructive Pulmonary Disease Among US Women and Men. Am J Epidemiol. 2010;171(7):776-784. doi:10.1093/aje/kwp455
28. Tabak C, Smit HA, Heederik D, Ocké MC, Kromhout D. Diet and chronic obstructive pulmonary disease: independent beneficial effects of fruits, whole grains, and alcohol (the MORGEN study). Clin Exp Allergy J Br Soc Allergy Clin Immunol. 2001;31(5):747-755. doi:10.1046/j.1365-2222.2001.01064.x
29. Zhai H, Wang Y, Jiang W. Fruit and Vegetable Intake and the Risk of Chronic Obstructive Pulmonary Disease: A Dose-Response Meta-Analysis of Observational Studies. BioMed Res Int. 2020;2020:3783481. doi:10.1155/2020/3783481
30. Varraso R, Barr RG, Willett WC, Speizer FE, Camargo CA. Fish intake and risk of chronic obstructive pulmonary disease in 2 large US cohorts. Am J Clin Nutr. 2015;101(2):354-361. doi:10.3945/ajcn.114.094516
31. Garcia-Larsen V, Potts JF, Omenaas E, et al. Dietary antioxidants and 10-year lung function decline in adults from the ECRHS survey. Eur Respir J. 2017;50(6). doi:10.1183/13993003.02286-2016
32. Kaluza J, Larsson SC, Orsini N, Linden A, Wolk A. Fruit and vegetable consumption and risk of COPD: a prospective cohort study of men. Thorax. 2017;72(6):500-509. doi:10.1136/thoraxjnl-2015-207851
33. Young RP, Hopkins RJ. A review of the Hispanic paradox: time to spill the beans? Eur Respir Rev Off J Eur Respir Soc. 2014;23(134):439-449. doi:10.1183/09059180.00000814
34. Hirayama F, Lee AH, Binns CW, et al. Soy consumption and risk of COPD and respiratory symptoms: a case-control study in Japan. Respir Res. 2009;10:56. doi:10.1186/1465-9921-10-56
35. Enquête Nationale sur la Consommation et les Dépenses des Ménages | Téléchargements | Site institutionnel du Haut-Commissariat au Plan du Royaume du Maroc. Accessed May 3, 2020. https://www.hcp.ma/downloads/Enquete-Nationale-sur-la-Consommation-et-les-Depenses-des-Menages_t21181.html
36. Ray NB, Hilsabeck KD, Karagiannis TC, McCord DE. Chapter 36 - Bioactive Olive Oil Polyphenols in the Promotion of Health. In: Singh RB, Watson RR, Takahashi T, eds. The Role of Functional Food Security in Global Health. Academic Press; 2019:623-637. doi:10.1016/B978-0-12-813148-0.00036-0
37. Mattioli V, Zanolin ME, Cazzoletti L, et al. Dietary flavonoids and respiratory diseases: a population-based multi-case–control study in Italian adults. Public Health Nutr. 2020;23(14):2548-2556. doi:10.1017/S1368980019003562
38. Walda IC, Tabak C, Smit HA, et al. Diet and 20-year chronic obstructive pulmonary disease mortality in middle-aged men from three European countries. Eur J Clin Nutr. 2002;56(7):638-643. doi:10.1038/sj.ejcn.1601370
39. de Batlle J, Sauleda J, Balcells E, et al. Association between Ω3 and Ω6 fatty acid intakes and serum inflammatory markers in COPD. J Nutr Biochem. 2012;23(7):817-821. doi:10.1016/j.jnutbio.2011.04.005
40. Jiang R, Jacobs DR, He K, et al. Associations of dairy intake with CT lung density and lung function. J Am Coll Nutr. 2010;29(5):494-502.
41. Butler LM, Koh WP, Lee HP, Tseng M, Yu MC, London SJ. Prospective Study of Dietary Patterns and Persistent Cough with Phlegm among Chinese Singaporeans. Am J Respir Crit Care Med. 2006;173(3):264-270. doi:10.1164/rccm.200506-901OC
42. Salari-Moghaddam A, Milajerdi A, Larijani B, Esmaillzadeh A. Processed red meat intake and risk of COPD: A systematic review and dose-response meta-analysis of prospective cohort studies. Clin Nutr Edinb Scotl. 2019;38(3):1109-1116. doi:10.1016/j.clnu.2018.05.020
43. de Batlle J, Mendez M, Romieu I, et al. Cured meat consumption increases risk of readmission in COPD patients. Eur Respir J. 2012;40(3):555-560. doi:10.1183/09031936.00116911
44. Jiang R, Paik DC, Hankinson JL, Barr RG. Cured meat consumption, lung function, and chronic obstructive pulmonary disease among United States adults. Am J Respir Crit Care Med. 2007;175(8):798-804. doi:10.1164/rccm.200607-969OC
45. Bartal M. COPD and tobacco smoke. Monaldi Arch Chest Dis Arch Monaldi Mal Torace. 2005;63(4):213-225. doi:10.4081/monaldi.2005.623
2. El Rhazi K, Nejjari C, Romaguera D, et al. Adherence to a Mediterranean diet in Morocco and its correlates: cross-sectional analysis of a sample of the adult Moroccan population. BMC Public Health. 2012;12:345. doi:10.1186/1471-2458-12-345
3. Morocco country nutrition profile. Global Nutrition Report. Published 17:02:03.175006+00:00. Accessed May 27, 2019. https://globalnutritionreport.org/nutrition-profiles/africa/northern-africa/morocco/
4. Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532-555. doi:10.1164/rccm.200703-456SO
5. El Rhazi K, Nejjari C, BenJelloun MC, El Biaze M, Attassi M, Garcia-Larsen V. Prevalence of chronic obstructive pulmonary disease in Fez, Morocco: results from the BOLD study. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2016;20(1):136-141. doi:10.5588/ijtld.15.0029
6. Duffy S, Barnett S, Civic B, Criner GJ, A James Mamary MD, others. Risk of death by comorbidity prompting rehospitalization following the initial COPD hospitalization. Chronic Obstr Pulm Dis J COPD Found. 2015;2(1):17-22.
7. Scoditti E, Massaro M, Garbarino S, Toraldo DM. Role of Diet in Chronic Obstructive Pulmonary Disease Prevention and Treatment. Nutrients. 2019;11(6). doi:10.3390/nu11061357
8. Fischer A, Johansson I, Blomberg A, Sundström B. Adherence to a Mediterranean-like Diet as a Protective Factor Against COPD: A Nested Case-Control Study. COPD. 2019;16(3-4):272-277. doi:10.1080/15412555.2019.1634039
9. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348(26):2599-2608. doi:10.1056/NEJMoa025039
10. Kaluza J, Harris HR, Linden A, Wolk A. Long-term consumption of fruits and vegetables and risk of chronic obstructive pulmonary disease: a prospective cohort study of women. Int J Epidemiol. 2018;47(6):1897-1909. doi:10.1093/ije/dyy178
11. Kaluza J, Harris H, Linden A, Wolk A. Long-term unprocessed and processed red meat consumption and risk of chronic obstructive pulmonary disease: a prospective cohort study of women. Eur J Nutr. 2019;58(2):665-672. doi:10.1007/s00394-018-1658-5
12. Gutiérrez-Carrasquilla L, Sánchez E, Hernández M, et al. Effects of Mediterranean Diet and Physical Activity on Pulmonary Function: A Cross-Sectional Analysis in the ILERVAS Project. Nutrients. 2019;11(2). doi:10.3390/nu11020329
13. El Rhazi K, Nejjari C, Zidouh A, Bakkali R, Berraho M, Barberger Gateau P. Prevalence of obesity and associated sociodemographic and lifestyle factors in Morocco. Public Health Nutr. 2011;14(1):160-167. doi:10.1017/S1368980010001825
14. Buist AS, Vollmer WM, Sullivan SD, et al. The Burden of Obstructive Lung Disease Initiative (BOLD): rationale and design. COPD. 2005;2(2):277-283.
15. World Health Organization. Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation, Geneva, 8-11 December 2008. World Health Organization; 2011.
16. Enright P, Vollmer WM, Lamprecht B, et al. Quality of spirometry tests performed by 9893 adults in 14 countries: the BOLD Study. Respir Med. 2011;105(10):1507-1515.
17. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med. 2017;195(5):557-582. doi:10.1164/rccm.201701-0218PP
18. El Kinany K, Garcia-Larsen V, Khalis M, et al. Adaptation and validation of a food frequency questionnaire (FFQ) to assess dietary intake in Moroccan adults. Nutr J. 2018;17(1):61. doi:10.1186/s12937-018-0368-4
19. Khalis M, Garcia-Larsen V, Charaka H, et al. Update of the Moroccan food composition tables: Towards a more reliable tool for nutrition research. J Food Compos Anal. 2020;87:103397. doi:10.1016/j.jfca.2019.103397
20. Thiébaut A, Kesse E, Com-Nougué C, Clavel-Chapelon F, Bénichou J. Ajustement sur l’apport énergétique dans l’évaluation des facteurs de risque alimentaires. Rev DÉpidémiologie Santé Publique. 2004;52(6):539-557. doi:10.1016/S0398-7620(04)99093-1
21. Bach-Faig A, Berry EM, Lairon D, et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011;14(12A):2274-2284. doi:10.1017/S1368980011002515
22. Serra-Majem L, Tomaino L, Dernini S, et al. Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns. Int J Environ Res Public Health. 2020;17(23):8758. doi:10.3390/ijerph17238758
23. Martín-Luján F, Catalin RE, Salamanca-González P, et al. A clinical trial to evaluate the effect of the Mediterranean diet on smokers lung function. NPJ Prim Care Respir Med. 2019;29(1):40. doi:10.1038/s41533-019-0153-7
24. Papanikolaou Y, Fulgoni VL. Certain Grain Foods Can Be Meaningful Contributors to Nutrient Density in the Diets of U.S. Children and Adolescents: Data from the National Health and Nutrition Examination Survey, 2009-2012. Nutrients. 2017;9(2). doi:10.3390/nu9020160
25. Veronese N, Solmi M, Caruso MG, et al. Dietary fiber and health outcomes: an umbrella review of systematic reviews and meta-analyses. Am J Clin Nutr. 2018;107(3):436-444. doi:10.1093/ajcn/nqx082
26. Kan H, Stevens J, Heiss G, Rose KM, London SJ. Dietary fiber, lung function, and chronic obstructive pulmonary disease in the atherosclerosis risk in communities study. Am J Epidemiol. 2008;167(5):570-578. doi:10.1093/aje/kwm343
27. Varraso R, Willett WC, Camargo CA. Prospective Study of Dietary Fiber and Risk of Chronic Obstructive Pulmonary Disease Among US Women and Men. Am J Epidemiol. 2010;171(7):776-784. doi:10.1093/aje/kwp455
28. Tabak C, Smit HA, Heederik D, Ocké MC, Kromhout D. Diet and chronic obstructive pulmonary disease: independent beneficial effects of fruits, whole grains, and alcohol (the MORGEN study). Clin Exp Allergy J Br Soc Allergy Clin Immunol. 2001;31(5):747-755. doi:10.1046/j.1365-2222.2001.01064.x
29. Zhai H, Wang Y, Jiang W. Fruit and Vegetable Intake and the Risk of Chronic Obstructive Pulmonary Disease: A Dose-Response Meta-Analysis of Observational Studies. BioMed Res Int. 2020;2020:3783481. doi:10.1155/2020/3783481
30. Varraso R, Barr RG, Willett WC, Speizer FE, Camargo CA. Fish intake and risk of chronic obstructive pulmonary disease in 2 large US cohorts. Am J Clin Nutr. 2015;101(2):354-361. doi:10.3945/ajcn.114.094516
31. Garcia-Larsen V, Potts JF, Omenaas E, et al. Dietary antioxidants and 10-year lung function decline in adults from the ECRHS survey. Eur Respir J. 2017;50(6). doi:10.1183/13993003.02286-2016
32. Kaluza J, Larsson SC, Orsini N, Linden A, Wolk A. Fruit and vegetable consumption and risk of COPD: a prospective cohort study of men. Thorax. 2017;72(6):500-509. doi:10.1136/thoraxjnl-2015-207851
33. Young RP, Hopkins RJ. A review of the Hispanic paradox: time to spill the beans? Eur Respir Rev Off J Eur Respir Soc. 2014;23(134):439-449. doi:10.1183/09059180.00000814
34. Hirayama F, Lee AH, Binns CW, et al. Soy consumption and risk of COPD and respiratory symptoms: a case-control study in Japan. Respir Res. 2009;10:56. doi:10.1186/1465-9921-10-56
35. Enquête Nationale sur la Consommation et les Dépenses des Ménages | Téléchargements | Site institutionnel du Haut-Commissariat au Plan du Royaume du Maroc. Accessed May 3, 2020. https://www.hcp.ma/downloads/Enquete-Nationale-sur-la-Consommation-et-les-Depenses-des-Menages_t21181.html
36. Ray NB, Hilsabeck KD, Karagiannis TC, McCord DE. Chapter 36 - Bioactive Olive Oil Polyphenols in the Promotion of Health. In: Singh RB, Watson RR, Takahashi T, eds. The Role of Functional Food Security in Global Health. Academic Press; 2019:623-637. doi:10.1016/B978-0-12-813148-0.00036-0
37. Mattioli V, Zanolin ME, Cazzoletti L, et al. Dietary flavonoids and respiratory diseases: a population-based multi-case–control study in Italian adults. Public Health Nutr. 2020;23(14):2548-2556. doi:10.1017/S1368980019003562
38. Walda IC, Tabak C, Smit HA, et al. Diet and 20-year chronic obstructive pulmonary disease mortality in middle-aged men from three European countries. Eur J Clin Nutr. 2002;56(7):638-643. doi:10.1038/sj.ejcn.1601370
39. de Batlle J, Sauleda J, Balcells E, et al. Association between Ω3 and Ω6 fatty acid intakes and serum inflammatory markers in COPD. J Nutr Biochem. 2012;23(7):817-821. doi:10.1016/j.jnutbio.2011.04.005
40. Jiang R, Jacobs DR, He K, et al. Associations of dairy intake with CT lung density and lung function. J Am Coll Nutr. 2010;29(5):494-502.
41. Butler LM, Koh WP, Lee HP, Tseng M, Yu MC, London SJ. Prospective Study of Dietary Patterns and Persistent Cough with Phlegm among Chinese Singaporeans. Am J Respir Crit Care Med. 2006;173(3):264-270. doi:10.1164/rccm.200506-901OC
42. Salari-Moghaddam A, Milajerdi A, Larijani B, Esmaillzadeh A. Processed red meat intake and risk of COPD: A systematic review and dose-response meta-analysis of prospective cohort studies. Clin Nutr Edinb Scotl. 2019;38(3):1109-1116. doi:10.1016/j.clnu.2018.05.020
43. de Batlle J, Mendez M, Romieu I, et al. Cured meat consumption increases risk of readmission in COPD patients. Eur Respir J. 2012;40(3):555-560. doi:10.1183/09031936.00116911
44. Jiang R, Paik DC, Hankinson JL, Barr RG. Cured meat consumption, lung function, and chronic obstructive pulmonary disease among United States adults. Am J Respir Crit Care Med. 2007;175(8):798-804. doi:10.1164/rccm.200607-969OC
45. Bartal M. COPD and tobacco smoke. Monaldi Arch Chest Dis Arch Monaldi Mal Torace. 2005;63(4):213-225. doi:10.4081/monaldi.2005.623