Diet and COPD: How have recent epidemiological studies added to the current knowledge on this association?
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Summary: Previously, the importance of a diet-COPD relationship has been recognised in epidemiological research. However, several uncertainties, including residual confounding by smoking and assessment of a temporal diet-COPD relationship, have previously been highlighted . In the recent 5 years, there has been a shift to dietary pattern assessments and their implications on lung function and COPD. These recent studies have added knowledge to the current evidence on diet and COPD, particularly in their explorations of dietary patterns and combined food effects, as opposed to assessments of individual foods and nutrients. Additionally, evidence has suggested that a ‘healthy’ diet such as the ‘prudent’ diet may have beneficial implications on COPD [16, 17, 19]. These conclusions are in light with the globally recognised importance of healthy eating, and in essence, have important implications on public health. However, no studies to date have investigated the temporality of this association and to what extent smoking modifies this association. As a result, the interpretation of current evidence is not sufficient to establish causality in the association between diet and COPD. The current challenge is to prospectively identify the role of smoking on this relationship by comparing smokers and non-smokers. Moreover, future studies are needed to elucidate on the impact of diet on the development and course of COPD. This will allow us to definitively establish causality, and in essence will have important implications for further public health research.