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A review of the Hispanic paradox: time to spill the beans?

Robert P. Young, Raewyn J. Hopkins
European Respiratory Review 2014 23: 439-449; DOI: 10.1183/09059180.00000814
Robert P. Young
1Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. 2School of Biological Sciences, University of Auckland, Auckland, New Zealand
1Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. 2School of Biological Sciences, University of Auckland, Auckland, New Zealand
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  • For correspondence: roberty@adhb.govt.nz
Raewyn J. Hopkins
1Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. 2School of Biological Sciences, University of Auckland, Auckland, New Zealand
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Abstract

Past epidemiological observations and recent molecular studies suggest that chronic obstructive pulmonary disease (COPD) and lung cancer are closely related diseases, resulting from overlapping genetic susceptibility and exposure to aero-pollutants, primarily cigarette smoke. Statistics from the American Lung Association and American Cancer Society reveal that mortality from COPD and lung cancer are lowest in Hispanic subjects and generally highest in African American subjects, with mortality in non-Hispanic white subjects and Asian subjects in between. This observation, described as the “Hispanic paradox”, persists after adjusting for confounding variables, notably smoking exposure and sociodemographic factors. While differences in genetic predisposition might underlie this observation, differences in diet remain a possible explanation. Such a hypothesis is supported by the observation that a diet high in fruit and vegetables has been shown to confer a protective effect on both COPD and lung cancer. In this article, we hypothesise that a diet rich in legumes may explain, in part, the Hispanic paradox, given the traditionally high consumption of legumes (beans and lentils) by Hispanic subjects. Legumes are very high in fibre and have recently been shown to attenuate systemic inflammation significantly, which has previously been linked to susceptibility to COPD and lung cancer in large prospective studies. A similar protective effect could be attributed to the consumption of soy products (from soybeans) in Asian subjects, for whom a lower incidence of COPD and lung cancer has also been reported. This hypothesis requires confirmation in cohort studies and randomised control trials, where the effects of diet on outcomes can be carefully examined in a prospective study design.

Footnotes

  • For editorial comments see page 410.

  • Conflict of interest: Disclosures can be found alongside the online version of this article at err.ersjournals.com

  • Provenance: Submitted article, peer reviewed.

  • Received January 23, 2014.
  • Accepted January 31, 2014.
  • ©ERS 2014

ERR articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

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A review of the Hispanic paradox: time to spill the beans?
Robert P. Young, Raewyn J. Hopkins
European Respiratory Review Dec 2014, 23 (134) 439-449; DOI: 10.1183/09059180.00000814

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A review of the Hispanic paradox: time to spill the beans?
Robert P. Young, Raewyn J. Hopkins
European Respiratory Review Dec 2014, 23 (134) 439-449; DOI: 10.1183/09059180.00000814
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  • Article
    • Abstract
    • Introduction
    • The COPD–lung cancer link
    • Systemic inflammation in the COPD–lung cancer link
    • The Hispanic paradox
    • Legumes/beans and systemic inflammation
    • Other ethnic groups and the consumption of legumes
    • Conclusion
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