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BACKGROUND: Epidemiological evidence on the relationship between fish consumption and chronic obstructive pulmonary disease (COPD) is limited, especially among Chinese. OBJECTIVES: To explore the prospective association between fish consumption and COPD among a large population-based Chinese cohort. METHODS: The China Kadoorie Biobank (CKB) recruited over 0.5 million participants from ten geographically diverse regions across China from 2004 to 2008. Consumption frequency of fish at baseline was assessed by a validated food frequency questionnaire. 169,188 men and 252,238 women who had no prior COPD and other major chronic diseases at baseline were included in our analyses. Cox proportional hazard models were employed to estimate the hazard ratio (HR) and 95% confidence interval (CI) for fish consumption categories in relation to incident COPD. RESULTS: During a median follow-up of 11.1 years, 5542 incident COPD cases were documented. Fish consumption was inversely associated with COPD risk among women, with a 17% reduction in risk for participants who consumed fish ≥4 days/week compared with non-consumption (HR: 0.83; 95% CI: 0.70, 0.99; p for trend = 0.017), whereas we did not observe such a dose-response relationship among men (HR: 0.89; 95% CI: 0.76, 1.05; p for trend = 0.373). The joint analysis showed that COPD risk was 38% and 48% lower in men and women who consumed fish ≥4 days/week and had a healthy lifestyle (having ≥4 of the following healthy lifestyle factors: not smoking currently, never or rarely drinking alcohol, adequate physical activity, BMI 18.5-23.9 kg/m2, normal waist circumference, reasonable diet), compared with participants with fish consumption <4 days/week and unhealthy lifestyle (≤1 factors). CONCLUSION: Higher fish consumption was associated with lower COPD risk among Chinese women but not men. Such association was independent of lifestyle factors. Eating adequate fish with an overall healthy lifestyle might help to lower the risk of COPD.

Original publication




Journal article


J Nutr

Publication Date



COPD, diet, fish, lifestyle, obstructive lung disease