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Published ahead of print on October 20, 2005, doi:10.1164/rccm.200506-901OC

Am. J. Respir. Crit. Care Med., Volume 173, Number 3, February 2006, 264-270

A more recent version of this article appeared on February 1, 2006
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Submitted on June 10, 2005
Accepted on October 19, 2005

Prospective Study of Dietary Patterns and Persistent Cough with Phlegm among Chinese Singaporeans

Lesley M Butler1, Woon-Puay Koh2, Hin-Peng Lee2, Marilyn Tseng3, Mimi C Yu4, and Stephanie J London5*

1 Department of Public Health Sciences, Division of Epidemiology, University of California - Davis, Davis, California, USA, 2 Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 3 Division of Population Science, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA, 4 University of Minnesota Cancer Center, Minneapolis, Minnesota, USA, 5 Epidemiology Branch, National Institute of Environmental Health Sciences, Department of Health and Human Services, National Institutes of Health, Research Triangle Park, North Carolina, USA

* To whom correspondence should be addressed. E-mail: london2{at}niehs.nih.giv.

Rationale: Using principal components analysis to examine dietary patterns complements the evaluation of individual food and nutrient intake in relation to health outcomes, but has not yet been applied to nonmalignant respiratory disease or symptoms. Objective: To examine the relation between patterns of dietary intake at baseline and new-onset of persistent cough with phlegm in a population-based cohort of Singapore Chinese. Methods: A 165-item validated food frequency questionnaire was administered in-person at baseline in 1993. We identified 623 cases of incident cough with phlegm among 52,325 subjects by telephone interview from 1999 through 2004. We identified two distinct food patterns: a "eat-dim sum" pattern characterized by pork and chicken dim sum foods and noodle dishes, and a "vegetable-fruit-soy" pattern characterized by vegetables, fruit and soyfood items. Main Results: The meat-dim sum pattern was positively associated with new-onset cough with phlegm (odds ratio=1.43; 95% confidence interval: 1.08, 1.89; comparing fourth to first quartile, P for trend=0.02,), after adjustment for age, gender, total energy intake, smoking, education and non-starch polysaccharide intake, a protective factor for cough with phlegm in this cohort. Weaker associations were seen for more chronic symptoms and for incident asthma. A weak inverse association for the vegetable-fruit-soy pattern disappeared after adjustment for non-starch polysaccharide intake. Conclusion: A diet rich in meats, sodium plus refined carbohydrates may increase risk of developing cough with phlegm, independently of the apparent beneficial effects of a diet high in non-starch polysaccharides in this Singapore Chinese cohort.
Key words: Asthma, chronic bronchitis; COPD; diet; signs and symptoms




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