Coffee and marijuana may sharply reduce the risk for early death from Hep C?

In the News
AUGUST 30, 2018

Coffee, Pot Linked to Lower Mortality From Hepatitis C
Increased consumption of coffee and marijuana may sharply reduce the risk for early death from hepatitis C infection, researchers have found.

The study of more than 1,200 patients with HCV and HIV found that those who drank the most coffee and used marijuana regularly or daily had more than a 60% lower risk for death from the infection over a five-year period.

How cannabis in particular might reduce mortality is unclear, but the researchers, led by Maria-Patrizia Carrieri, PhD, of the Université Aix Marseille, in France, noted that the substance has been previously associated with a reduced risk for insulin resistance and steatosis, two conditions that could increase mortality in patients with HCV.

Read the article:

 https://www.gastroendonews.com/In-the-News/Article/08-18/Coffee-Pot-Linked-to-Lower-Mortality-From-Hepatitis-C/52403

Observational Data: Drinking coffee can be part of a healthy diet

Cleveland Clinic Reports

Can Drinking Coffee Help You Live Longer?

New research says you can drink as much as eight cups a day.
Cleveland Clinic’s Julia Zumpano, RD, did not take part in the research, but says the study showed that regular ground coffee had the most benefit. The researchers noted their results were based on observational data and should be interpreted with caution. “Nevertheless, these results provide further evidence that coffee drinking can be part of a healthy diet and may provide reassurance to those who drink coffee and enjoy it,” the authors concluded. Complete results of the study can be found in JAMA Internal Medicine.

Source: https://health.clevelandclinic.org/can-drinking-coffee-help-you-live-longer/

Of Interest

July 2017
Observational evidence published in Annals of Internal Medicine
Journal Review - Richard Lehman
Coffee: wake up and smell the confounding

Two big observational studies suggest that coffee drinking is associated with longevity. You drink coffee, and would like to believe good things about coffee. So your first instinct, as you sip the aromatic liquid and feel the caffeine buzz, is to rejoice. But you are a scientist: look closer. The first study is of the EPIC cohort, where E stands for European. Over half a million Europeans recorded their coffee consumption on one occasion. Those who claimed to drink the most had a slightly higher rate of survival at 16.4 years than those who said they did not drink coffee. There was a markedly lower rate of death from gastrointestinal causes. Epidemiologically, it’s quite intriguing, but I defy anyone to conduct a randomised trial for a sufficient length of time. So at best we can say that coffee drinking is unlikely to be harmful. The same message emerges from a study of 185 855 Americans of mixed ethnicity, after adjustment for confounders. The coffee drinkers were a bit less likely to die over a period of 16 years, compared with non-coffee-drinkers. Don’t let your coffee get cold while you muse on these matters. Observational evidence is observational evidence and will never be anything more.

Source: https://blogs.bmj.com/bmj/2017/07/17/richard-lehmans-journal-review-17-july-2017/

Coffee Drinkers Are More Likely To Live Longer. Decaf May Do The Trick, Too

NPR
Coffee Drinkers Are More Likely To Live Longer. Decaf May Do The Trick, Too 
July 2, 2018

Coffee is far from a vice.

There's now lots of evidence pointing to its health benefits, including a possible longevity boost for those of us with a daily coffee habit.

The latest findings come from a study published Monday in JAMA Internal Medicine that included about a half-million people in England, Scotland and Wales. Participants ranged in age from 38 to 73.

Read more....

8 recent reports on diet’s protective, risk-increasing effects on liver health

8 recent reports on diet’s protective, risk-increasing effects on liver health
March 23, 2018

Diet and lifestyle play a large role in liver health. Lately, researchers have made several important discoveries regarding the ties between diet and the gut microbiome, and identified specific dietary components that either have protective qualities for liver health or increase the risk for liver disease and cancer.

The following reports include details on diet’s effect on the gut microbiome, the increased risk for fatty liver disease among individuals with a high intake of red and processed meat, the protective effects of early childhood vitamin E intake and moderate coffee intake for adults, and a recent CDC report on adult binge drinking.

Read the complete article: https://www.healio.com/hepatology/steatohepatitis-metabolic-liver-disease/news/online/%7B52d2eb94-721c-4466-8632-13d3a3ccb049%7D/8-recent-reports-on-diets-protective-risk-increasing-effects-on-liver-health

Coffee May Increase Life Expectancy in Liver Disease

Perspective > Hepatology Highlights   

COMMENTARY

Coffee May Increase Life Expectancy in Liver Disease
Rowen K. Zetterman, MD

Two recent publications from the United States and Europe have again focused attention on the positive effects of coffee in reducing all-cause human mortality.^[1,2] Furthermore, other studies are adding to our knowledge of coffee's potential ability to reduce the risk for liver disease and its progression. These studies led me to update the information regarding coffee and its beneficial clinical effects.

Coffee is consumed worldwide. Although we may not yet understand the mechanisms of coffee's positive effects,^[3,4] a growing number of publications continue to indicate that it can benefit persons with liver disease, slow formation of liver fibrosis, reduce the risk for hepatocellular carcinoma even in persons without cirrhosis, and lower overall mortality in people with or without liver disease.

Read more: https://www.medscape.com/viewarticle/887970

Three or more cups of coffee daily halves mortality risk in patients with both HIV and HCV

Of Interest
The latest scoop on the health benefits of coffee
September 25, 2017 Harvard Health Blog
Robert H. Shmerling, MD, Faculty Editor, Harvard Health Publications
Over the last several decades, coffee has been among the most heavily studied dietary components. And the news is mostly good. Moderate coffee consumption (three to four cups per day) has been linked with longer lifespan.
Continue reading....

Three or more cups of coffee daily halves mortality risk in patients with both HIV and HCV
September 25, 2017
Novel five-year study highlights importance of behaviors such as coffee drinking and not smoking on health and survival of HIV-infected patients, report investigators in the Journal of Hepatology

Amsterdam, The Netherlands, September 25, 2017 - Patients infected by both human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are at specific risk of end-stage liver disease and greater risk of cardiovascular diseases and cancer. In addition, HIV infection accelerates the progression of chronic hepatitis C to fibrosis and development of cirrhosis and end-stage liver disease. In these HIV-HCV co-infected patients, drinking at least three cups of coffee each day halved the risk of all-cause mortality according to a new study published in the Journal of Hepatology.

This study is the first to investigate the relationship between coffee consumption and the risk of all-cause mortality in HIV-HCV co-infected patients. "This is a very exciting time for HCV research as a cure that can eradicate the virus is now available for all patients," explained lead investigator Dominique Salmon-Céron, MD, PhD, of the Service des Maladies Infectieuses et Tropicales, Hôpital Cochin, and Université Paris Descartes, Paris, France. "However, even when cured of HCV, patients co-infected with HIV have a higher risk of death with respect to the general population, due to an accelerated aging process that may result from cancer, complications related to diabetes and to liver disease, and from cardiovascular events."

Coffee is known to have anti-inflammatory and liver-protective properties. In the general population, drinking three or more cups of coffee a day has been found to be associated with a 14% reduction in the risk of all-cause mortality. This is probably due to the properties of polyphenols contained in coffee that can protect the liver and also reduce inflammation.

Investigators used data from a five-year follow-up of 1,028 HIV-HCV co-infected patients enrolled in the French national ANRS CO13-HEPAVIH cohort. ANRS CO13-HEPAVIH is an ongoing French nationwide prospective cohort of HIV-HCV co-infected patients that collects both medical and psychosocial/behavioral data over time via annual self-administered questionnaires.

At enrolment, one in four patients reported drinking at least three cups of coffee daily. Over the five years, 77 deaths occurred, almost half attributable to hepatitis C. However, the mortality risk was 80% lower in those who were cured of (i.e. who "cleared") hepatitis C thanks to treatment.

Further analysis showed that drinking at least three cups of coffee daily was associated with a 50% reduction in mortality risk even after taking into account HCV clearance, HIV- and HCV-related factors, and other sociobehavioral factors, such as having a steady partner and not smoking. Healthy behavior change should be promoted by physicians following HCV clearance.

This research highlights the importance of behaviors - coffee consumption and not smoking in particular - on reduced mortality risk. These results can help promote behavioral changes in HIV-HCV patients, which in turn can result in improved survival. With respect to coffee consumption, individuals who do not drink coffee because of caffeine can still benefit from the comparable anti-inflammatory effects of decaffeinated coffee.

First author Maria Patrizia Carrieri, PhD, of the HEPAVIH Study Group, Faculté de Médecine, Aix Marseille University, INSERM, IRD, SESSTIM, Marseilles, France, observed that coffee consumption provides more protective effects on mortality in the HIV-HCV population than in the general population.

"The results of our study show that while curing HCV is fundamental, it must be complemented by behavioral changes if we are to improve health and survival in HIV-infected patients whether or not they cleared HCV. "I think we need to better monitor coffee consumption, together with other behaviors, such as alcohol use, smoking, physical activity, and to propose interventions to our patients which facilitate healthy behaviors even after HCV clearance. We also suggest that those patients who cannot tolerate a high intake of caffeine should consider drinking a few cups of decaffeinated coffee a day," commented Dr. Salmon-Céron. "Accordingly, I believe that the benefits of coffee extracts and supplementing dietary intake with other anti-inflammatory compounds need to be evaluated in HIV-HCV patients."

https://www.eurekalert.org/pub_releases/2017-09/e-tom092517.php

Summary for Patients - Is Coffee Consumption Associated With Lower Risk for Death?

In The Media
Richard Lehman’s journal review—17 July 2017
Ann Intern Med  11 July 2017
Coffee: wake up and smell the confounding
Two big observational studies suggest that coffee drinking is associated with longevity. You drink coffee, and would like to believe good things about coffee. So your first instinct, as you sip the aromatic liquid and feel the caffeine buzz, is to rejoice. But you are a scientist: look closer. The first study is of the EPIC cohort, where E stands for European. Over half a million Europeans recorded their coffee consumption on one occasion. Those who claimed to drink the most had a slightly higher rate of survival at 16.4 years than those who said they did not drink coffee. There was a markedly lower rate of death from gastrointestinal causes. Epidemiologically, it’s quite intriguing, but I defy anyone to conduct a randomised trial for a sufficient length of time. So at best we can say that coffee drinking is unlikely to be harmful. The same message emerges from a study of 185 855 Americans of mixed ethnicity, after adjustment for confounders. The coffee drinkers were a bit less likely to die over a period of 16 years, compared with non-coffee-drinkers. Don’t let your coffee get cold while you muse on these matters. Observational evidence is observational evidence and will never be anything more.
The Lancet 15 July 2017  Vol 390

Coffee Drinkers Really Do Live Longer
In two new studies published in the Annals of Internal Medicine, researchers delved into the coffee-drinking habits of more than 700,000 people in the U.S. and in 10 European countries. The scientists were particularly interested in looking at death rates among people of non-white populations. In both studies, people in these groups who drank more coffee tended to have a lower risk of dying during the study period than those who drank less coffee, or no coffee.
Source - Time

Annals of Internal Medicine: Summaries for Patients
Is Coffee Consumption Associated With Lower Risk for Death?                     

11 July 2017

Published: Ann Intern Med. 2017.

DOI: 10.7326/P17-9041

Article, Author, and Disclosure Information

What is the problem and what is known about it so far?
Coffee is one of the most commonly consumed beverages in the world. Some studies have found that drinking more coffee is associated with a lower risk for death. These studies have included mostly white populations, and it is not clear whether this association is found in other groups. In addition, the relationship between coffee drinking and risk for death might differ according to the way coffee is prepared.

Why did the researchers do these 2 studies?
To determine whether the association between coffee consumption and risk for death differs according to ethnicity and cultural differences in how coffee is prepared.

Who was studied?
One of the studies included more than 185,000 adults from a range of ethnicities (African American, Latino, Native Hawaiian, Japanese American, and white). The other included more than 520,000 adults from 10 European countries, where people prepare coffee in different ways.

How were the studies done?
In both studies, the authors asked participants whether they drank coffee and how much, together with questions about other factors that influence a person's risk for health problems and death (for example, cigarette smoking, exercise, diabetes, and heart disease). They then followed the participants for years to see how many died and whether the death rate differed for those who had reported drinking more coffee.

What did the researchers find?
In both studies, people who reported drinking more coffee tended to live longer than those who reported drinking less. This was true in African Americans, Japanese Americans, Latinos, and whites. This finding did not differ among the 10 European countries. Rates of death from certain diseases seemed to be lower in those who reported drinking more coffee than in those who did not drink coffee, although the rate of death from ovarian cancer may have been higher.

What were the limitations of the studies?
These studies were based on a single report of how often the participants drank coffee, which may have changed over the years they were followed and might not have been accurate. In addition, although the researchers tried to account for this, people who say they drink a lot of coffee may differ from those who do not in other ways that may affect their health.

What are the implications of the studies?
Although drinking coffee cannot be recommended as being good for your health on the basis of these kinds of studies, the studies do suggest that for many people, no long-term harm will result from drinking coffee.
Source - Annals of Internal Medicine

Abstract

Association of Coffee Consumption With Total and Cause-Specific Mortality Among Nonwhite Populations

Coffee Drinking and Mortality in 10 European Countries: A Multinational Cohort Study

NEJM Journal Watch

Coffee Studies Imply More Is Better, but...
By Joe Elia
Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Two large studies find an inverse association between coffee consumption and mortality, but recommending more of the stuff "would be premature," according to an editorial in the Annals of Internal Medicine.

The EPIC study followed over a half-million subjects in 10 European countries for an average of 16 years. It found that those in the highest quartile of consumption had significantly lower all-cause mortality than nonconsumers after adjustment for smoking and other covariates.

The Multiethnic Cohort study followed some 200,000 Hawaiians and Californians, also for an average of 16 years. As with EPIC, higher consumption was associated with lower all-cause mortality after adjustment. The effect was seen across all ethnic groups, Native Hawaiians excepted.

However, two editorials weaken the brew, pointing out that unmeasured confounders, such as higher income leading to higher coffee consumption, may be at play. Coffee-lovers may rejoice that at least no adverse effects were found.

Link(s):
Annals of Internal Medicine article on EPIC study (Free abstract)
Annals of Internal Medicine article on Multiethnic Cohort (Free abstract)
Annals of Internal Medicine editorial #1 (Subscription required)
Annals of Internal Medicine editorial #2 (Subscription required)
Background: Recent NEJM Journal Watch Cardiology coverage of coffee, tea, and the heart (Your NEJM Journal Watch subscription required)
Source - NEJM Journal Watch

Healio - In the Journals
Drinking coffee reduces risk for death
July 10, 2017
Among people of various ethnicities and cultures, higher coffee consumption — whether caffeinated or decaffeinated — was associated with all-cause and cause-specific mortality benefits, according to two new studies published in Annals of Internal Medicine.

Take a coffee or tea break to protect your liver

In Case You Missed It

Take a coffee or tea break to protect your liver

New study indicates that drinking even a few cups a day may prevent hardening of the liver, reports the Journal of Hepatology

J Hepatol. 2017;doi:10.1016/j.jhep.2017.03.013.

Amsterdam, The Netherlands, June 6, 2017 -

Chronic liver diseases rank as the 12th cause of death worldwide and many of these disorders are associated with unhealthy lifestyles. Conversely, a healthier lifestyle can help prevent or reverse liver disease. Liver-related mortality is closely related to the development of cirrhosis, the final consequence of progressive fibrosis, i.e. scarring of the liver resulting from chronic inflammation. According to a new study published in the Journal of Hepatology, researchers found that drinking coffee and herbal tea may protect against liver fibrosis, estimated as the degree of liver stiffness, which is high in extensive scarring of the liver. Because these beverages are popular, widely available, and inexpensive, they could have the potential to become important in the prevention of advanced liver disease.

"Over the past decades, we gradually deviated towards more unhealthy habits, including a sedentary lifestyle, decreased physical activity, and consumption of a 'Happy Diet'," explains lead author Louise J. M. Alferink, MD, of the Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands, "This Happy Diet, also known as the Western diet, is typically rich in unhealthy foods including processed foods lacking nutrients and artificial sugars. This has led not only to an obesity epidemic, but also to a rapid increase in the prevalence of non-alcoholic fatty liver disease (NAFLD), which is due to extensive accumulation of fat in the liver and resembles alcoholic liver disease in people who do not exceed two drinks a day of alcohol. In this context, examining accessible and inexpensive lifestyle strategies that have potential health benefits, such as coffee and tea consumption, is a viable approach to finding ways to halt the rapid increase of liver disease in developed countries."

Sarwa Darwish Murad, MD, PhD, principal investigator of the study and hepatologist at the Erasmus MC University Medical Center, continues "There is quite some epidemiological, but also experimental data suggesting that coffee has health benefits on liver enzyme elevations, viral hepatitis, NAFLD, cirrhosis, and liver cancer. Beyond the liver, coffee has been demonstrated to be inversely associated with overall mortality in the general population. The exact mechanism is unknown but it is thought that coffee exerts anti-oxidant effects. We were curious to find out whether coffee consumption would have a similar effect on liver stiffness measurements in individuals without chronic liver disease."

Data was gathered on 2,424 participants of the Rotterdam study, a large population-based cohort study including participants 45 years or older living in a suburb of Rotterdam, The Netherlands. All participants underwent an extensive physical work-up, including data collection for anthropometrics, blood sampling, hepatological imaging using abdominal ultrasound and Fibroscan®, which quantitatively measures liver stiffness. In addition, they completed an externally validated 389-item Food Frequency Questionnaire, which included detailed information on coffee and tea consumption.

Coffee and overall tea consumption was divided into three categories: none, moderate (>0-3 cups per day), and frequent (?3). Tea consumption was categorized by herbal, green, or black tea and further into none (0) or any (>0) consumption.

Investigators found that frequent coffee consumption was significantly associated with lower odds of high liver stiffness values (?8 kPa as proxy for liver fibrosis), i.e. less scarring of the liver, independent of lifestyle, metabolic, and environmental traits. When they looked at the whole range of liver stiffness values, they found that both frequent coffee and any herbal tea consumption, even in small amounts, were significantly associated with lower liver stiffness values. Finally, while no direct association was found between either coffee or tea and the presence of fat accumulation in the liver (NAFLD) per se, the effect of coffee on lowering the liver stiffness was significant in both the group with and without liver fat. The authors therefore concluded that frequent coffee and herbal tea seem to have beneficial effects on preventing liver scarring even before overt liver disease has developed.

However, some caution in the interpretation of the results is necessary, as underlined in an accompanying editorial by Salvatore Petta, MD, PhD, of the Section of Gastroenterology and Hepatology, Di.Bi.M.I.S., University of Palermo, Italy, and Giulio Marchesini, MD, of the Department of Medical and Surgical Sciences (DIMEC), ''Alma Mater" University, Bologna, Italy., In fact, the study included only an elderly Caucasian population and there were few participants in the no-coffee or no-tea control groups, which limit a straightforward conclusion about the effect of coffee and tea on the liver.. The amount of tea consumed was generally low, making estimation of any protective effect difficult. Further, they note that more than 100 components are present in coffee and tea, including polyphenols and caffeine, which are contained in both beverages in very different and variable amounts.

Hence, when asked "Should we add regular coffee and tea breaks to our daily life? Dr. Petta's and Dr. Marchesini's conclusion is, "Before this policy can be recommended, prospective studies are needed to identify the optimum amounts and the type(s) of coffee and tea leading to more favorable liver outcomes."

IMAGE: Using data from the Rotterdam Study researchers determined that frequent coffee and herbal tea consumption were inversely related with liver stiffness but not steatosis in the general population.

Credit: L. Alferink and S. Darwish Murad

Coffee Is Good For The Liver - The magical bean for liver diseases

Coffee Is Good For The Liver
Previous studies have demonstrated the positive effects of coffee on chronic liver diseases. For instance people with hepatitis C who drink higher amounts of coffee have a lower rate of disease progression than those who drink less coffee. As for moderate coffee consumption, a slower rate of fibrosis and cirrhosis has been reported.

In the following systematic review published May 2017 in BMJ coffee consumption was associated with a reduced risk for developing primary liver cancer (Hepatocellular Carcinoma). As reported; Increased consumption of caffeinated coffee and, to a lesser extent, decaffeinated coffee are associated with reduced risk of HCC, including in pre-existing liver disease.

Media Coverage Of The Article

Drinking coffee may help prevent liver cancer, study suggests

Those who consumed two cups a day had a 35% reduced risk and for those who drank five cups, the risk was halved. They found the protective effect for decaf was “smaller and less certain than for caffeinated coffee”.

The authors wrote: “It may be important for developing coffee as a lifestyle intervention in chronic liver disease, as decaffeinated coffee might be more acceptable to those who do not drink coffee or who limit their coffee consumption because of caffeine-related symptoms.”
Lead author Dr Oliver Kennedy, of the University of Southampton, said: “Coffee is widely believed to possess a range of health benefits, and these latest findings suggest it could have a significant effect on liver cancer risk.

Coffee: The magical bean for liver diseases

According to a mini review published May 28, 2017 in World Journal of Hepatology  the benefits of drinking coffee range from; liver enzyme laboratory test improvement to improved mortality from cirrhosis, HCC, as well as other malignancies, and chronic liver diseases secondary to HBV, HCV and NAFLD.

Read the full text online or download PDF

Patient Friendly Review

The evidence is in - drinking coffee is clearly beneficial for the liver, to learn more read this special report (published June 2016) by The British Liver Trust.

Coffee consumption and liver disease

Coffee consumption and liver disease

Previous studies have shown coffee consumption may significantly reduce the risk of hepatic fibrosis and cirrhosis and drinking more than 3 cups per day may modestly reduced risk to liver cancer. A 2016 study conducted in mice found drinking coffee could help reverse non-alcoholic fatty liver disease and published in Nutrients (2017) a review citing an oral presentation submitted to the Liver Meeting 2015 suggested; In NAFLD, HCV and HBV associated liver diseases coffee consumption, not tea, was associated with lower liver stiffness, a non-invasive marker of liver fibrosis. In addition, a meta-analysis presented at The Liver Meeting® 2016 found coffee significantly decreased risk of liver fibrosis among NAFLD patients who drank coffee on a regular basis compared to those who did not.

Coffee Drinking and Alcoholic and Nonalcoholic Fatty Liver Diseases and Viral Hepatitis in the Multiethnic Cohort

Recently published in Clinical Gastroenterology and Hepatology, researchers examined the relationship between coffee consumption and chronic hepatitis C,  non-alcoholic fatty liver disease, and alcoholic liver disease. An excerpt of the study, found online @ Healio.

Excerpt:

“Our data also suggest a possible effect of coffee intake on the fibrosis process in ALD and CHC and an effect of coffee on multiple pathways in NAFLD, possibly including inflammatory, steatotic and fibrotic processes

Commentary over at Healio.  

Coffee consumption associated with reduced risk for chronic liver disease
Setiawan VW, et al. Clin Gastroenterol Hepatol. 2017;doi:10.1016/j.cgh.2017.02.038.
March 14, 2017

Recent study data revealed an association between coffee consumption and a reduced risk for developing chronic liver disease, particularly in non-alcoholic fatty liver disease, alcoholic liver disease and chronic hepatitis C.

Continue reading....

Coffee Consumption and Herbal Tea Tied to Lower Liver Stiffness

Herbal Tea, Coffee Consumption Tied to Lower Liver Stiffness

Tea and coffee consumption is ubiquitous around the world. Both contain polyphenols, caffeine, as well as other chemical components. Polyphenols and caffeine are suspected to improve liver health; for example, previous research has suggested that coffee might prevent liver cirrhosis. However, whether or not this is true for fibrosis in the general population is not known.

AASLD Coverage
Nov 11, 2016
Herbal Tea, Coffee Consumption Tied to Lower Liver Stiffness
Herbal tea and coffee might protect the liver among healthy adults, according to findings presented at The Liver Meeting® 2016.

“High coffee consumption appears protective of liver stiffness even in individuals with no known liver disease,” reported lead study coauthor Louise J. Alferink, of the Gastroenterology and Hepatology of the Erasmus Medical Center, Rotterdam, Netherlands. 

Continue reading...

Additional updates @ MPR

People who drink coffee are less likely to develop nonalcoholic fatty liver disease (NAFLD), a new literature review suggests. And people with NAFLD who drink coffee regularly are less likely to develop liver fibrosis.

AASLD Coverage
Nov 12,2016

Drinking Coffee Found to Significantly Decrease NAFLD Risk
Coffee drinkers significantly decrease their risk of nonalcoholic fatty liver disease (NAFLD), and regular drinking also decreases risk of liver fibrosis, according to results of a systematic review and meta-analysis presented at The Liver Meeting® 2016.

“Whether consumption of coffee could be considered as a preventative measure against NAFLD needs further investigations,” reported Karn Wijarnpreecha, MD, of the department of internal medicine at Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY, and colleagues.
Continue reading...

Additional updates @ MPR

Weekend Reading: Coffee can play a role in reducing risks of cancer and diabetes

Coffee can play a role in reducing risks of cancer and diabetes

Good day folks, in this issue of "Weekend Reading" we point you to a podcast over at ABC Radio on the many health benefits of drinking coffee, hosted by Dr. Kruszelnicki.
Topics covered in the two part program include the effect of caffeine on; liver cancer, type II diabetes, prostate cancer, oral cancer, and heart disease.

But what about the side effects of drinking coffee, good or bad?

There is a body of evidence that some of the side effects of coffee may actually be good for you, and they appear to have nothing to do with caffeine. But Dr Karl Kruszelnicki's grind is the observational studies that make up the 'statistics' behind the health benefits.

Listen to the podcast or read the transcript;

Coffee is now good for us—or is it?
Part One - Listen here
July 12 2016
Yes, it is a drug, and so we should remember the words of Paracelsus, 'all drugs are poisons, what matters is the dose.' Based on the fact that coffee has been used widely for over a millennium, we would expect its bad side-effects would be fairly minimal—so long as we don't take too much.
Read the transcript

Part Two - Listen here
July 19,2016
Coffee can play a role in reducing risks of cancer and diabetes
It seems that beside caffeine, there are other natural chemicals in coffee that can help with medical conditions. With regard to liver cancer, two chemicals, kahweol and cafestrol, have direct cancer protection and anti-inflammatory properties. They seem to 'upregulate biochemical pathways in the liver that protect the body from toxins, including aflatoxin and other carcinogenic compounds'.
Read the transcript

Cheers!

Can More Coffee Lead to Less Liver Damage?

Can More Coffee Lead to Less Liver Damage?
Coffee alone, however, cannot reverse the lifestyle choices that result in cirrhosis
May 2, 2016 / By Digestive Health Team 

If you’re looking for a reason to have that extra cup of coffee in the morning, there is good news. Drinking two more cups of coffee each day has been linked to a dramatically lowered odds of the liver damage caused by excessive alcohol, a recent study found.

The analysis of nine studies totaling more than 430,000 participants found that drinking those two extra mugs of mud each day is linked to a 44 percent reduced risk of liver cirrhosis, a disease often caused by excessive alcohol consumption. Cirrhosis of the liver also can be caused by drugs and certain viral infections, such as hepatitis B and C. A growing cause of cirrhosis of the liver is fatty liver disease.

Cirrhosis is a slowly developing disease in which healthy liver tissue is replaced with scar tissue. The scar tissue blocks the flow of blood through the liver and slows the liver’s ability to process nutrients, hormones, drugs and natural toxins. It also reduces the production of proteins and other substances made by the liver. Cirrhosis eventually keeps the liver from working properly.

Cirrhosis of the liver is a serious condition that causes more than 1 million deaths per year.

 More coffee, less damage

The researchers found that in eight of the nine studies, the risk of cirrhosis declined as the number of cups of coffee consumed rose. While two cups of coffee dropped the risk of the disease by 44 percent, drinking four cups of coffee dropped it by 65 percent.

This led the researchers to conclude that increasing coffee consumption may substantially reduce the risk of cirrhosis.

It’s important to know that the research simply discovered an inverse association between coffee consumption and liver damage, says Jamile Wakim-Fleming, MD. The researchers did not look into why or how coffee consumption inversely links to liver disease, she says. Dr. Wakim-Fleming did not take part in the study.

Coffee and the liver

Coffee contains compounds that offer antioxidant effects and anti-inflammatory properties. But the beverage alone cannot reverse the lifestyle choices that result in cirrhosis.

“To say that coffee is going to reverse all of your liver damage and prevent you from needing a transplant or death and other consequences of cirrhosis is sending you the wrong message,” Dr. Wakim-Fleming says. “Coffee is not going to undo the damage done by years of excessive alcohol consumption or drug use.”

The study is a good starting point, and short of a medical treatment that cures alcoholic cirrhosis, coffee appears to have some benefit, Dr. Wakim-Fleming says.

“People should drink the two cups of coffee if they can tolerate it, but also — and more importantly — they should stop drinking alcohol altogether when they have damage to their liver,” she says.

She also cautions people about adding lots of sugar and cream to their coffee, which can increase your risk for cardiovascular problems.

“What we put in the coffee may change the whole outcome,” Dr. Wakim-Fleming says. “If you dump large amounts of sugar and milk in the coffee, then you’re probably destroying whatever health benefits coffee may have.”

Complete results of the study appear in the journal Alimentary Pharmacology and Therapeutics

Coffee consumption and the risk of cirrhosis

Coffee consumption and the risk of cirrhosis

Full Text - Alimentary Pharmacology & Therapeutics
Volume 43, Issue 5, pages 562–574, March 2016

The most recent issue of the Alimentary Pharmacology & Therapeutics characterized the relationship between coffee consumption and cirrhosis.

Liver cirrhosis is a large burden on global health, causing over one million deaths per year.

Observational studies have reported an inverse association between coffee and cirrhosis.

Dr Kennedy and colleagues from the United Kingdom performed a systematic review and meta-analysis to characterize the relationship between coffee consumption and cirrhosis.

The team searched for studies published until 2015 that reported odds ratios, relative risks or hazard ratios for cirrhosis stratified by coffee consumption.

The researchers calculated relative risks of cirrhosis for an increase in daily coffee consumption of 2 cups for each study and overall.

The team performed analyses by study design, type of cirrhosis and mortality.

The research team assessed the risk of bias in each study, and the overall quality of evidence for the effect of coffee on cirrhosis.

The team identified 5 cohort studies and 4 case–control studies involving 1990 cases and 432,133 participants.

The researchers observed a dose–response in most studies and overall.

The pooled relative risk of cirrhosis for a daily increase in coffee consumption of 2 cups was 0.56.

The relative risk pooled from cohort studies for a daily increase of 2 cups was 0.58, and from case–control studies it was 0.52.

The pooled relative risk of alcoholic cirrhosis for a daily increase of 2 cups was 0.62, and of death from cirrhosis it was 0.55.

Dr Kennedy’s team comments, “This meta-analysis suggests that increasing coffee consumption may substantially reduce the risk of cirrhosis.”

Summary Source 
Full Text

Aliment Pharmacol Ther 2016: 43(5): 562–574
15 February 2016

Drinking coffee may reduce the risk of liver cirrhosis

 Drinking coffee may reduce the risk of liver cirrhosis

Regular consumption of coffee was linked with a reduced risk of liver cirrhosis in a review of relevant studies published before July 2015.

In patients with cirrhosis, the liver becomes scarred often as a result of long-term and persistent injury from toxins like alcohol and viruses like hepatitis C. It can be fatal because it increases the risk of liver failure and cancer.

The analysis found that an extra 2 cups of coffee per day may reduce the risk of cirrhosis by 44%, and it may nearly halve the risk of dying from cirrhosis.

"Coffee appeared to protect against cirrhosis.This could be an important finding for patients at risk of cirrhosis to help to improve their health outcomes," said Dr. O. J. Kennedy, lead author of the Alimentary Pharmacology and Therapeutics analysis. "However, we now need robust clinical trials to investigate the wider benefits and harms of coffee so that doctors can make specific recommendations to patients."

Article Source - http://www.medicalnewstoday.com/releases/305923.php

Article: Systematic review with meta-analysis: coffee consumption and the risk of cirrhosis, O. J. Kennedy, P. Roderick, R. Buchanan, J. A. Fallowfield, P. C. Hayes and J. Parkes, Alimentary Pharmacology & Therapeutics, doi: 10.1111/apt.13523, published online 25 January 2016.

How coffee loves us back

Of Interest
Sept 17
Caffeine Decreases Risk of Hepatic Fibrosis in Male HCV Patients
In a cross-sectional study, researchers found that coffee and caffeine were associated with a decreased risk of developing advanced hepatic fibrosis among a majority of male veterans with hepatitis C virus infection, according to study data.

How coffee loves us back

By Alvin Powell, Harvard Staff Writer 

Health benefits a recurring theme in Harvard research

Coffee, said the Napoleon-era French diplomat Talleyrand, should be hot as hell, black as the devil, pure as an angel, sweet as love.

Bach wrote a cantata in its honor, writers rely on it, and, according to legend, a pope blessed it. Lady Astor once reportedly remarked that if she were Winston Churchill’s wife, she’d poison his coffee, to which Churchill acerbically replied: “If I were married to you, I’d drink it.”

Coffee is everywhere, through history and across the world. And increasingly, science is demonstrating that its popularity is a good thing.

Harvard scientists have for years put coffee under the microscope. Last year, researchers announced they had discovered six new human genes related to coffee and reconfirmed the existence of two others. The long-running Nurses’ Health Study has found that coffee protects against type 2 diabetes and cardiovascular disease. Researchers are continuing to follow up on 2001 findings that it protects against Parkinson’s disease.

The work at Harvard is just part of an emerging picture of coffee as a potentially powerful elixir against a range of ailments, from cancer to cavities.

Sanjiv Chopra, a professor of medicine at Harvard Medical School and Harvard-affiliated Beth Israel Deaconess Medical Center, has been so impressed he’s become something of a coffee evangelist. The author of several books, Chopra included a chapter on coffee in his 2010 book, “Live Better, Live Longer.”

Chopra first became aware of the potentially powerful protective effects of coffee when a study revealed that consumption lowers levels of liver enzymes and protects the liver against cancer and cirrhosis. He began asking students, residents, and fellows on the liver unit to quiz patients about their coffee habits, finding repeatedly that none of the patients with liver ailments drank coffee.

Chopra himself makes sure to have several cups a day, and encourages others to do the same. Though other researchers are less bold in their dietary recommendations, they’re convinced enough to continue investigations into the benefits.

Alberto Ascherio, a professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health and a professor of medicine at HMS, has been studying the potential anti-Parkinson’s effects first suggested in the 2001 findings. That study showed that four or five cups of coffee daily cut disease risk nearly in half compared with little or no caffeine.

Professor of Nutrition and Epidemiology and Professor of Medicine Frank Hu, who leads the diabetes section of the long-running Nurses’ Health Study, has become interested in whether coffee drinking affects total mortality.

“I’m not a huge coffee drinker, two to three cups a day,” Hu said. “[But] I like it and, thinking about the extra benefits, that’s comforting.”

Last year, a Harvard team led by then-research associate Marilyn Cornelis — today an assistant professor at Northwestern University — traced coffee’s fingerprints to the human genome, discovering six new genes related to coffee consumption and reconfirming two others found earlier. The six genes included two related to metabolism, two related to coffee’s psychoactive effects, and two whose exact purpose in coffee consumption is unclear, but which are related to lipid and glucose metabolism.

Daniel Chasman, an associate professor of medicine at HMS and associate geneticist at Harvard-affiliated Brigham and Women’s Hospital, who worked with Cornelis on the study, said caffeine consumption habits are highly heritable and that the genes they found appear to explain about 7 percent of the heritability. That’s a significant amount, he said, considering how strong an influence culture also plays on coffee consumption.

Though the links between coffee and better health have become considerably clearer, what exactly confers the benefit remains murky. Caffeine alone does not explain the effects. For starters, some of the benefits are seen even with decaf, which has prompted researchers to turn their attention to the many other active compounds — including antioxidants such as chlorogenic acid — in your morning cup.

“Coffee is a complex beverage. It’s very difficult to pinpoint which component of coffee is responsible for the benefit,” Hu said. “There are numerous bioactive compounds.”

Other highlights from Harvard research include:
A 2005 study exploring concerns that too much coffee was bad for blood pressure found no link between higher blood pressure and coffee and found some suggestion that it improved blood pressure.
Regular coffee drinking was linked in a 2011 Harvard study to lower risk of a deadly form of prostate cancer.

Also in 2011, a study showed that drinking four or more cups a day lowered the rate of depression among women.

A 2012 study tied three cups a day to a 20 percent lower risk of basal cell carcinoma.

A 2013 Harvard study linked coffee consumption to a reduced risk of suicide.

Also in 2013, a Harvard analysis of 36 studies covering more than a million people found that even heavy coffee consumption did not increase the risk of cardiovascular disease and that three to five cups of coffee daily provided the most protection against cardiovascular disease.

Also in 2014, Harvard Chan School researchers found that increasing coffee consumption by more than a cup a day over a four-year period reduced type 2 diabetes risk by 11 percent.

The same study showed that those who decreased their coffee consumption by more than a cup a day increased their type 2 diabetes risk by 17 percent.

“That first cup of coffee in the morning is happiness.” Chopra said. “It’s a real joy.”

Source - Harvard Gazette 

Published on Sep 29, 2015

Coffee is everywhere, through history and across the world. And increasingly, science is demonstrating that its popularity is a good thing.

The work at Harvard is just part of an emerging picture of coffee as a potentially powerful elixir against a range of ailments, from cancer to cavities.

Coffee reduces the risk of hepatic fibrosis in Hep C

Clinical Gastroenterology & Hepatology
August 2015 Volume 13, Issue 8, Pages 1521–1531.e3
2015 Aug;13(8):1521-1531.e3. doi: 10.1016/j.cgh.2015.01.030

Full Text Now Available, Click here...

Coffee reduces the risk of hepatic fibrosis in Hep C

Coffee and caffeine are associated with decreased risk of advanced hepatic fibrosis among patients with Hepatitis C, reports the latest issue of the Clinical Gastroenterology & Hepatology.

Coffee or caffeine has been proposed to protect against hepatic fibrosis, but few data are available on their effects in patients with chronic hepatitis C virus (HCV) infection.

Dr Hashem El-Serag and colleagues from Texas, USA conducted a cross-sectional study of veterans with chronic HCV infection to evaluate the association between daily intake of caffeinated and decaffeinated coffee, tea, and soda, and level of hepatic fibrosis, based on the FibroSURE test.

Models were adjusted for multiple potential confounders including age, alcohol abuse, and obesity.

The hepatoprotective effects were with an average daily intake of 100 mg or more of caffeine
Clinical Gastroenterology & Hepatology

Among 910 patients with chronic HCV infection, 98% were male and 38% had advanced hepatic fibrosis.

The research team found that daily intake of caffeinated coffee was higher among controls than patients with advanced fibrosis.

In contrast, the team noted that daily intake of caffeinated tea or soda did not differ between the groups.

The researchers found that a higher percentage of controls than patients with advanced fibrosis consumed 100 mg or more of caffeine daily from all sources.

Controls also received a larger proportion of their caffeine from coffee.

The team observed that the hepatoprotective effects of an average daily intake of 100 mg or more of caffeine, and 1 cup or more of caffeinated tea by non–coffee drinkers persisted after adjustment for confounders, including insulin resistance.

Dr El-Serag's team concludes, "A modest daily caffeine intake may protect against advanced hepatic fibrosis in men with chronic HCV infection."

"Additional research is needed to confirm these findings in women and in people with other chronic liver diseases."

Abstract source

Coffee and Caffeine Are Associated With Decreased Risk of Advanced Hepatic Fibrosis Among Patients With Hepatitis C

Natalia Khalaf, Donna White, Fasiha Kanwal, David Ramsey, Sahil Mittal, Shahriar Tavakoli-Tabasi,

Jill Kuzniarek, Hashem B. El-Serag

Published Online: March 14, 2015

Discussion Only

View Full Text Online

We found that self-reported coffee drinking and caffeine consumption from beverages were associated with a lower risk of advanced hepatic fibrosis in patients with chronic HCV but had no association with degree of hepatic inflammation. An average daily intake of an estimated 100 mg of caffeine from coffee, tea, or soda was associated with an approximately one-third reduction in odds of advanced fibrosis, although higher intake did not seem to confer any additional benefit. Interestingly, tea intake in those who did not consume coffee also was found to be associated with a decreased risk of advanced fibrosis. The inverse association between 100 mg or more of caffeine intake daily and advanced hepatic fibrosis remained significant after adjustment for potential confounders (eg, age, alcohol use, BMI, MELD score, and metabolic syndrome), and was attenuated when adjusted for HOMA-IR status. The inverse association between caffeine consumption and degree of fibrosis was found using caffeine intake data from the year preceding study recruitment, however, lifetime caffeine intake did not seem to influence this relationship.

Our finding that caffeine intake is associated with a decreased risk of advanced HCV-related fibrosis is in line with several other studies that have suggested a beneficial effect of caffeine on hepatic function in various liver diseases, including nonalcoholic steatohepatitis, alcoholic liver disease, and primary sclerosing cholangitis.⁴x4Klatsky, A.L. and Armstrong, M.A. Alcohol, smoking, coffee, and cirrhosis. Am J Epidemiol. 1992; 136: 1248–1257

PubMedSee all References^{, 6}x6Tanaka, K., Tokunaga, S., Kono, S. et al. Coffee consumption and decreased serum γ-glutamyltransferase and aminotransferase activities among male alcohol drinkers. Int J Epidemiol. 1998; 27: 438–443

CrossRef | PubMed | Scopus (97)See all References^{, 10}x10Ruhl, C.E. and Everhart, J.E. Coffee and caffeine consumption reduce the risk of elevated serum alanine aminotransferase activity in the United States. Gastroenterology. 2005; 128: 24–32

Abstract | Full Text | Full Text PDF | PubMed | Scopus (131)See all References^{, 33}x33Birerdinc, A., Stepanova, M., Pawloski, L. et al. Caffeine is protective in patients with non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2012; 35: 76–82

CrossRef | PubMed | Scopus (32)See all References^{, 34}x34Chen, S., Teoh, N.C., Chitturi, S. et al. coffee and non-alcoholic fatty liver disease: brewing evidence for hepatoprotection?. J Gastroenterol Hepatol. 2014; 29: 435–441

CrossRef | PubMed | Scopus (5)See all References^{, 35}x35Andersen, I.M., Tengesdal, G., Lie, B.A. et al. Effects of coffee consumption, smoking, and hormones on risk for primary sclerosing cholangitis. Clin Gastroenterol Hepatol. 2014; 12: 1019–1028

Abstract | Full Text | Full Text PDF | PubMed | Scopus (5)See all References^{, 36}x36Lammert, C., Juran, B.D., Schlicht, E. et al. Reduced coffee consumption among individuals with primary sclerosing cholangitis but not primary biliary cirrhosis. Clin Gastroenterol Hepatol. 2014; 12: 1562–1568

Abstract | Full Text | Full Text PDF | PubMed | Scopus (3)See all References^{, 37}x37Corrao, G., Lepore, A.R., Torchio, P. et al. The effect of drinking coffee and smoking cigarettes on the risk of cirrhosis associated with alcohol consumption. A case-control study. Eur J Epidemiol. 1994; 10: 657–664

CrossRef | PubMed | Scopus (85)See all References^{, 38}x38Klatsky, A.L., Morton, C., Udaltsova et al. Coffee, cirrhosis, and transaminase enzymes. Arch Intern Med. 2006; 166: 1190–1195

CrossRef | PubMed | Scopus (105)See all References It also is consistent with an analysis of the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) trial, which found that daily coffee consumption was associated with slower disease progression in patients with chronic HCV-related bridging fibrosis and cirrhosis who had failed to respond to treatment with pegylated interferon and ribavirin. However, in contrast to our findings, which suggest no substantial additional benefit of caffeine intake of 100 mg/day or more, they found a dose-dependent response with coffee drinkers who reported 3 or more cups daily experiencing the greatest (∼53%) reduced risk of disease progression (ie, to decompensation or HCC) compared with non–coffee drinkers.¹⁶x16Freedman, N.D., Everhart, J.E., Lindsay, K.L. et al. Coffee intake is associated with lower rates of liver disease progression in chronic hepatitis C. Hepatology. 2009; 50: 1360–1369

CrossRef | PubMed | Scopus (81)See all References16 We hypothesize that the primary explanation for this discrepancy is the difference in the spectrum of HCV-related liver disease among studies because the HALT-C trial was restricted to cirrhotic patients, whereas our study population included the full spectrum of HCV-related liver disease. However, other differences in study design and among populations also may have contributed to this discrepancy. Our results suggesting that a modest dose of caffeine intake (∼100 mg/d) was associated with a significantly reduced risk of advanced fibrosis in veterans with chronic HCV are similar to an earlier comparable pilot study in 91 HCV-positive veterans.³⁹x39White, D.L., Richardson, P.A., Al-Saadi, M. et al. Dietary history and physical activity and risk of advanced liver disease in veterans with chronic hepatitis C infection. Dig Dis Sci. 2011; 56: 1835–1847

CrossRef | PubMedSee all References39 The consistency in these results over time further supports the internal validity of our findings.

In contrast to our results, Costentin et al¹⁷x17Costentin, C.E., Roudot-Thoraval, F., Zafrani, E.S. et al. Association of caffeine intake and histological features of chronic hepatitis C. J Hepatol. 2011; 54: 1123–1129

Abstract | Full Text | Full Text PDF | PubMed | Scopus (30)See all References17 found no significant protective association in their study of 238 French patients with treatment-naive chronic HCV. However, they did find that daily caffeine consumption of more than 408 mg (equivalent to ≥3 cups of coffee) was an independent predictor of lower histologic activity grade of hepatitis. Several factors may explain this discrepancy, including differences in populations such as higher average caffeine intake but lower rates of obesity and alcohol abuse overall in the French study population, differences in methods of estimating caffeine intake, and known substantial variability in caffeine found in coffee and tea based on methods of production and preparation.

Our findings suggest that a total combined caffeine intake or dose of 100 mg or more daily is associated with a significant decrease in risk of hepatic fibrosis, but without further risk reduction with higher coffee or caffeine doses. However, the optimal hepatoprotective dose of caffeine in HCV-infected patients overall is unclear. Although some studies suggested the strongest benefit from coffee consumption was at 3 or more cups daily, or approximately 400 mg of caffeine,¹⁶x16Freedman, N.D., Everhart, J.E., Lindsay, K.L. et al. Coffee intake is associated with lower rates of liver disease progression in chronic hepatitis C. Hepatology. 2009; 50: 1360–1369

CrossRef | PubMed | Scopus (81)See all References^{, 17}x17Costentin, C.E., Roudot-Thoraval, F., Zafrani, E.S. et al. Association of caffeine intake and histological features of chronic hepatitis C. J Hepatol. 2011; 54: 1123–1129

Abstract | Full Text | Full Text PDF | PubMed | Scopus (30)See all References other studies reported a significant reduction in the risk in HCV-related hepatic fibrosis associated with an intake of 1 or 2 cups of cups of coffee daily.¹¹x11Modi, A.A., Feld, J.J., Park, Y. et al. Increased caffeine consumption is associated with reduced hepatic fibrosis. Hepatology. 2010; 51: 201–209

CrossRef | PubMed | Scopus (84)See all References^{, 40}x40Machado, S.R., Parise, E.R., and de Carvalho, L. Coffee has hepatoprotective benefits in Brazilian patients with chronic hepatitis C even in lower daily consumption than in American and European populations. Braz J Infect Dis. 2014; 18: 170–176

CrossRef | PubMed | Scopus (1)See all References Our results suggest that as little as 100 mg or more of caffeine daily may be beneficial in a general HCV-infected population with a high prevalence of other risk factors for advanced liver disease. However, our power to evaluate the benefit of higher intake likely was limited by the small number of our study participants who reported drinking higher quantities of caffeinated beverages. Nonetheless, if validated in other HCV-infected populations in the United States, our results suggest that a relatively low (and therefore potentially more tolerable dose) of caffeine, particularly from caffeinated coffee and possibly from tea, may convey a substantial reduction in fibrosis progression.

Several mechanisms have been suggested by which caffeine may act to reduce the risk of advanced fibrosis.⁴¹x41Kumari, R. and Kim, W.R. Coffee: a panacea or snake oil for the liver?. Clin Gasteroenterol Hepatol. 2014; 12: 1569–1571

Abstract | Full Text | Full Text PDF | PubMed | Scopus (1)See all References41 Caffeine functions as a nonselective adenosine-receptor antagonist and a phosphodiesterase inhibitor with a broad range of attendant effects including inhibition of growth factors that contribute to hepatic fibrosis.⁴²x42Peng, Z., Fernandez, P., Wilder, T. et al. Ecto-5′-nucleotidase (CD73)-mediated extracellular adenosine production plays a critical role in hepatic fibrosis. FASEB J. 2008; 22: 2263–2272

CrossRef | PubMed | Scopus (49)See all References^{, 43}x43Arauz, J., Moreno, M.G., Cortes-Reynosa, P. et al. Coffee attenuates fibrosis by decreasing the expression of TGF-β and CTGF in a murine model of liver damage. J Appl Toxicol. 2013; 33: 970–979

CrossRef | PubMed | Scopus (14)See all References^{, 44}x44Gressner, O.A., Lahme, B., Rehbein, K. et al. Pharmacological application of caffeine inhibits TGF-beta-stimulated connective tissue growth factor expression in hepatocytes via PPARgamma and SMAD2/3-dependent pathways. J Hepatol. 2008; 49: 758–767

Abstract | Full Text | Full Text PDF | PubMed | Scopus (61)See all References Caffeine is metabolized in the liver primarily by CYP1A2, with reduced expression of CYP1A2 correlated with fibrosis progression in a study of HCV patients.⁴⁵x45Nakai, K., Tanaka, H., Hanada, K. et al. Decreased expression of cytochromes P450 1A2, 2E1, and 3A4 and drug transporters Na+-taurocholate-cotransporting polypeptide, organic cation transporter 1, and organic anion-transporting peptide-C correlates with the progression of liver fibrosis in chronic hepatitis C patients. Drug Metab Dispos. 2008; 36: 1786–1793

CrossRef | PubMed | Scopus (41)See all References45 Caffeine also has been shown in animal and in vitro studies to act as an antioxidant.⁴⁶x46Devasagayam, T.P., Kamat, J.P., Mohan, H. et al. Caffeine as an antioxidant: inhibition of lipid peroxidation induced by reactive oxygen species. Biochim Biophys Acta. 1996; 1282: 63–70

CrossRef | PubMed | Scopus (149)See all References46 Other studies have suggested that the primary hepatoprotective benefit of caffeine is associated with caffeinated coffee intake.⁴x4Klatsky, A.L. and Armstrong, M.A. Alcohol, smoking, coffee, and cirrhosis. Am J Epidemiol. 1992; 136: 1248–1257

PubMedSee all References^{, 6}x6Tanaka, K., Tokunaga, S., Kono, S. et al. Coffee consumption and decreased serum γ-glutamyltransferase and aminotransferase activities among male alcohol drinkers. Int J Epidemiol. 1998; 27: 438–443

CrossRef | PubMed | Scopus (97)See all References^{, 11}x11Modi, A.A., Feld, J.J., Park, Y. et al. Increased caffeine consumption is associated with reduced hepatic fibrosis. Hepatology. 2010; 51: 201–209

CrossRef | PubMed | Scopus (84)See all References^{, 16}x16Freedman, N.D., Everhart, J.E., Lindsay, K.L. et al. Coffee intake is associated with lower rates of liver disease progression in chronic hepatitis C. Hepatology. 2009; 50: 1360–1369

CrossRef | PubMed | Scopus (81)See all References^{, 47}x47Gallus, S., Tavani, A., Negri, E. et al. Does coffee protect against liver cirrhosis?. Ann Epidemiol. 2002; 12: 202–205

Abstract | Full Text | Full Text PDF | PubMed | Scopus (60)See all References However, this could be the effect of generally higher daily cumulative caffeine intake in coffee drinkers compared with consumers of other caffeinated beverages overall, or with pharmacodynamic differences in effects given the substantial differences in caffeine per unit intake of caffeinated coffee in comparison with tea or soda. Finally, it also has been postulated that other constituents of coffee, such as diterpenes, polyphenols, kahweol, and cafestrerol, which have anti-oxidant activity, also may be responsible for the particular hepatoprotective effect of coffee.⁴⁸x48Scalbert, A. and Williamson, G. Dietary intake and bioavailability of polyphenols. J Nutr. 2000; 130: 2073S–2085S

PubMedSee all References^{, 49}x49Cavin, C., Holzhaeuser, D., Scharf, G. et al. Cafestol and kahweol, two coffee specific diterpenes with anticarcinogenic activity. Food Chem Toxicol. 2002; 40: 1155–1163

CrossRef | PubMed | Scopus (194)See all References^{, 50}x50Huber, W.W., Scharf, G., Rossmanith, W. et al. The coffee components kahweol and cafestol induce gamma-glutamylcysteine synthetase, the rate limiting enzyme of chemoprotective glutathione synthesis, in several organs of the rat. Arch Toxicol. 2002; 75: 685–694

CrossRef | PubMedSee all References^{, 51}x51Lee, C. Antioxidant ability of caffeine and its metabolites based on the study of oxygen radical absorbing capacity and inhibition of LDL peroxidation. Clin Chim Acta. 2000; 295: 141–154

CrossRef | PubMed | Scopus (98)See all References However, studies, including ours, have not shown that decaffeinated coffee exerts the same effect on liver disease as caffeinated coffee.¹¹x11Modi, A.A., Feld, J.J., Park, Y. et al. Increased caffeine consumption is associated with reduced hepatic fibrosis. Hepatology. 2010; 51: 201–209

CrossRef | PubMed | Scopus (84)See all References^{, 47}x47Gallus, S., Tavani, A., Negri, E. et al. Does coffee protect against liver cirrhosis?. Ann Epidemiol. 2002; 12: 202–205

Abstract | Full Text | Full Text PDF | PubMed | Scopus (60)See all References

Inflammation is another known risk factor for progression to fibrosis in chronic HCV,⁵²x52Leandro, G., Mangia, A., Hui, J. et al. Relationship between steatosis, inflammation, and fibrosis in chronic hepatitis C: a meta-analysis of individual patient data. Gastroenterology. 2006; 130: 1636–1642

Abstract | Full Text | Full Text PDF | PubMed | Scopus (324)See all References52 and the role of coffee as an anti-inflammatory agent in nonliver diseases has been suggested.²x2Andersen, L.F., Jacobs, D.R. Jr., Carlsen, M.H. et al. Consumption of coffee is associated with reduced risk of death attributed to inflammatory and cardiovascular diseases in the Iowa Women's Health Study. Am J Clin Nutr. 2006; 83: 1039–1046

PubMedSee all References2 In our study, we found no significant association between caffeine intake and the severity of hepatic inflammation, in line with findings by Freedman et al¹⁶x16Freedman, N.D., Everhart, J.E., Lindsay, K.L. et al. Coffee intake is associated with lower rates of liver disease progression in chronic hepatitis C. Hepatology. 2009; 50: 1360–1369

CrossRef | PubMed | Scopus (81)See all References16 that coffee intake was not associated with lower baseline hepatic inflammation. Prior work has shown that insulin resistance worsens hepatic inflammation in HCV patients,¹⁸x18Negro, F. Insulin resistance and HCV: will new knowledge modify clinical management?. J Hepatol. 2006; 45: 514–519

Abstract | Full Text | Full Text PDF | PubMed | Scopus (48)See all References18 and a meta-analysis suggested that part of the hepatoprotective effect of coffee in part may be related to an associated reduction in insulin resistance and type 2 diabetes mellitus.¹⁹x19Van Dam, R.M. and Hu, F.B. Coffee consumption and risk of type 2 diabetes a systematic review. JAMA. 2005; 294: 97–104

CrossRef | PubMed | Scopus (346)See all References19 In our study, caffeine intake was associated inversely with insulin resistance via the surrogate marker of the HOMA-IR score in nondiabetic participants.

Therefore, one potential mechanism linking caffeine intake or the associated lifestyle with decreased risk of advanced fibrosis is the amelioration of insulin resistance. Further studies are needed to better elucidate the underlying pathophysiological mechanisms by which caffeine or its metabolites and other constituents of coffee account for the positive health benefits seen particularly with caffeinated coffee consumption in liver disease patients.

We found that an average of 100 mg or more of caffeine daily from sodas and teas does not have the same protective effect as 100 mg or more of caffeine daily from combined sources (coffee, tea, soda) or from coffee alone, suggesting that caffeine alone may not entirely explain the effect of coffee on liver disease. Although several prior studies have not shown a lower risk of liver disease progression in those who consume caffeine from noncoffee sources such as tea⁴x4Klatsky, A.L. and Armstrong, M.A. Alcohol, smoking, coffee, and cirrhosis. Am J Epidemiol. 1992; 136: 1248–1257

PubMedSee all References^{, 11}x11Modi, A.A., Feld, J.J., Park, Y. et al. Increased caffeine consumption is associated with reduced hepatic fibrosis. Hepatology. 2010; 51: 201–209

CrossRef | PubMed | Scopus (84)See all References^{, 16}x16Freedman, N.D., Everhart, J.E., Lindsay, K.L. et al. Coffee intake is associated with lower rates of liver disease progression in chronic hepatitis C. Hepatology. 2009; 50: 1360–1369

CrossRef | PubMed | Scopus (81)See all References^{, 47}x47Gallus, S., Tavani, A., Negri, E. et al. Does coffee protect against liver cirrhosis?. Ann Epidemiol. 2002; 12: 202–205

Abstract | Full Text | Full Text PDF | PubMed | Scopus (60)See all References or soda,⁴⁷x47Gallus, S., Tavani, A., Negri, E. et al. Does coffee protect against liver cirrhosis?. Ann Epidemiol. 2002; 12: 202–205

Abstract | Full Text | Full Text PDF | PubMed | Scopus (60)See all References47 this could be related to differing caffeine content, other ingredients in addition to caffeine that may be partly responsible for the proposed hepatoprotective effects of coffee, or to substantial differences in study design or populations. Among the 413 noncoffee drinkers in our current study, intake of at least 1 cup of caffeinated tea daily was more common in the mild fibrosis control group, and after controlling for potential confounders, this significance was even more pronounced. This finding provides further evidence for the protective role of caffeine from any source against the progression of liver disease.
In regards to soda, an understudied source of caffeine, we found consumption of more than 1 can of caffeinated soda daily to be associated with a decreased risk of hepatic fibrosis, supporting that caffeine likely plays a major role in coffee’s hepatoprotective effects. On multivariate nonstratified analysis, more than 1 can of caffeinated soda daily remained significantly associated with a decreased risk of hepatic fibrosis, with some attenuation after controlling for possible confounders (age, alcohol, BMI, MELD score, and the presence of the metabolic syndrome). When adjusted for self-reported diabetes and HOMA-IR scores, there was a nonsignificant trend toward a decreased risk of fibrosis (adjusted OR, 0.75; 95% CI, 0.55–1.02; P = .063). However, in analyzing soda intake in the subgroup of non–coffee drinkers (n = 413), there was no notable difference in the risk of hepatic fibrosis (P = .41). The findings may indicate that caffeine from soda has hepatoprotective effects, but we cannot exclude the possibility that increased soda consumption reflects an increased intake of caffeinated beverages overall, including coffee. As with coffee, decaffeinated tea and soda were not found to be associated with a decreased risk of liver disease.

Our study had several strengths, including being a large study that examined the association between caffeinated coffee intake and HCV-related liver disease, and adds to the limited research in US populations. It also adds to the sparse literature on the effects of caffeinated tea and soda intake. In addition, we obtained and analyzed information on the consumption of decaffeinated coffee, tea, and soda to better elucidate the mechanisms underlying the potential hepatoprotective effects of caffeine and coffee on liver disease. Finally, our novel use of a validated noninvasive marker for liver fibrosis, the validated FibroSURE test,²⁶x26Halfon, P., Bourliere, M., Deydier, R. et al. Independent prospective multicenter validation of biochemical markers (fibrotest-actitest) for the prediction of liver fibrosis and activity in patients with chronic hepatitis C: the fibropaca study. Am J Gastroenterol. 2006; 101: 547–555

CrossRef | PubMed | Scopus (109)See all References^{, 27}x27Ngo, Y., Munteanu, M., Messous, D. et al. A prospective analysis of the prognostic value of biomarkers (FibroTest) in patients with chronic hepatitis C. Clin Chem. 2006; 52: 1887–1896

CrossRef | PubMed | Scopus (159)See all References^{, 28}x28Morali, G., Maor, Y., Klar, R. et al. Fibrotest-Actitest: the biochemical marker of liver fibrosis–the Israeli experience. Isr Med Assoc J. 2007; 9: 588–591

PubMedSee all References^{, 29}x29Imbert-Bismut, F., Ratziu, V., Pieroni, L. et al. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet. 2001; 357: 1069–1075

Abstract | Full Text | Full Text PDF | PubMed | Scopus (1004)See all References^{, 30}x30Grigorescu, M., Rusu, M., Neculoiu, D. et al. The FibroTest value in discriminating between insignificant and significant fibrosis in chronic hepatitis C patients. The Romanian experience. J Gastrointest Liver Dis. 2007; 16: 31–37

PubMedSee all References^{, 31}x31Poynard, T., Imbert-Bismut, F., Ratziu, V. et al. Biochemical markers of liver fibrosis in patients infected by hepatitis C virus: longitudinal validation in a randomized trial. J Viral Hepat. 2002; 9: 128–133

CrossRef | PubMed | Scopus (188)See all References^{, 32}x32Poynard, T., Munteanu, M., Ngo, Y. et al. ActiTest accuracy for the assessment of histological activity grades in patients with chronic hepatitis C, an overview using Obuchowski measure. Gastroenterol Clin Biol. 2010; 34: 388–396

CrossRef | PubMed | Scopus (20)See all References allowed evaluation of a large and diverse HCV patient group, many of whom would have been precluded from biopsy based on highly prevalent comorbid conditions in this population.

Our study also had some limitations. Given the observational retrospective nature of the study, a causal association cannot be made. We studied a select patient population of HCV-monoinfected, largely male veterans, and therefore the findings may not be applicable to women with HCV or co-infected patients. Beverage consumption was self-reported, and caffeine intake was estimated based on the average reported intake, and therefore may not accurately reflect the actual intake given the known variability in caffeine levels in coffee and tea of the same type owing to differences in production and preparation. However, any misclassification should be nondifferential (ie, similar among cases and controls) and therefore any possible bias should be toward the null or finding of no association. A potential for reverse causality may be present if patients with more advanced liver disease are averse to drinking caffeine-containing beverages including coffee; however, we did not enroll patients with decompensated liver disease. We also found that the decreased risk of advanced fibrosis with an average daily intake of 100 mg or more of caffeine or 1 or more cups of tea in non–coffee drinkers remained significant or nearly significant after adjusting for MELD scores and insulin resistance. In total, 40% of our participants were classified as marijuana users, and we found no significant association with the degree of hepatic fibrosis or inflammation and marijuana use. However, we did not have information on the duration or frequency of marijuana use, a limitation of our study.⁵³x53Hézode, C., Roudot-Thoraval, F., Nguyen, S. et al. Daily cannabis smoking as a risk factor for progression of fibrosis in chronic hepatitis C. Hepatology. 2005; 42: 63–71

CrossRef | PubMed | Scopus (163)See all References53 Prior studies also have suggested women who consume alcohol may have a less pronounced response to the hepatoprotective effects of caffeine as measured by γ-glutamyltransferase levels,⁵⁴x54Danielsson, J., Kangastupa, P., Laatikainen, T. et al. Dose- and gender-dependent interactions between coffee consumption and serum GGT activity in alcohol consumers. Alcohol Alcohol. 2013; 48: 303–307

CrossRef | PubMed | Scopus (5)See all References54 and in animal models, females may recover more slowly from hepatic injury than males.⁵⁵x55Wang, Y., Ye, F., Ke, Q. et al. Gender-dependent histone deacetylases injury may contribute to differences in liver recovery rates of male and female mice. Transplant Proc. 2013; 45: 463–473

Abstract | Full Text | Full Text PDF | PubMedSee all References55 Our study participants were largely male (n = 888), with only 22 females represented. As such, our study lacked the statistical power to find a notable gender-specific difference in the hepatoprotective effects of caffeine or coffee.

In conclusion, we found that an average daily intake of 100 mg or more of caffeine was associated with a lower risk of hepatic fibrosis in a general clinical population with chronic HCV infection. We further showed that in non–coffee drinkers, daily caffeinated tea intake also may protect against progressive liver disease in this population. Our study further suggests that caffeinated coffee overall and caffeinated tea in non–coffee drinkers likely provide the most benefit in liver disease compared with other caffeinated beverages or decaffeinated coffee. Future prospective studies are warranted to determine the optimal dose and preparation of caffeinated beverage intake that could be safely and tolerably recommended for prevention of progressive liver disease in HCV patients in routine clinical practice.

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