Original reportCoffee, Caffeine, and the Risk of Liver Cirrhosis☆
Introduction
The use of coffee has long been accompanied by debate about its possible risks and beneficial effects. Suspected adverse effects of coffee on the development of several pathological conditions (coronary heart disease, certain cancers, and reproductive abnormalities) remain controversial (1). On the other hand, a protective effect of coffee on liver cell damage caused by alcohol has been suggested by several studies. Inverse correlations between coffee consumption and serum liver enzyme levels have been reported in several studies 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. Moreover, an association between coffee consumption and reduced risk of liver cirrhosis (LC) has been observed in a prospective epidemiological investigation (13), and in a case-control study (14).
Several questions still remain unresolved. First, coffee consumption might be a marker of other lifestyle factors that could act as protective factors. For example, several epidemiological studies suggests that certain dietary patterns might be associated with the onset of LC 15, 16, 17, and it is likely that there are important correlations among dietary and lifestyle factors (specific aliments, coffee, alcohol, smoking, etc.). Second, it is not yet clear whether the suspected protective effect of coffee is because of caffeine, the most prominent pharmacologically active substance contained in coffee (1), or to other substances. Third, to our knowledge, it has not been determined whether coffee acts only to inhibit the harmful effects of alcohol on the liver cell, or if similar effects are also present for other known determinants of LC (e.g., chronic infection by hepatitis B and C viruses–HBV and HCV, respectively).
We attempted to address these problems, using the data of the SIDECIR (Italian Study on Liver Cirrhosis Determinants) project, a new Italian collaborative case-control study (18). The main aims were: i) to estimate the independent effect of coffee, and of other beverages containing caffeine, on the risk of LC with adjustment for the known LC risk factors and for several lifestyle factors; ii) to explore the joint action of coffee, alcohol, HBV, and HCV infections, on the risk of LC.
Section snippets
Selection of Cases and Controls
From 1994 through 1998, 338 LC cases were recruited from those admitted to the Medical Departments of 19 Italian collaborative centers. Cases were admitted for signs of liver decompensation (ascites, jaundice, edema) or bleeding from ruptured esophageal varices, and in whom the diagnosis of LC was made for the first time. Forty-eight patients were excluded: 17 because of invalidating hepatic encephalopathy, 19 because of coexisting hepatocellular carcinoma, and 12 with a final ascertained
Results
High degrees of concordance were obtained between interviewers and supervisor (ranging from 0.79 to 0.85 for alcohol and caloric intakes, respectively), as well as between collaterals and patients (ranging from 0.78 to 0.89 for smoking and carbohydrates, respectively). This was also the situation within patients interviewed on two occasions (ranging from 0.87 to 0.93 for alcohol and caloric intakes, respectively) or interviewed with reference to two life periods (ranging from 0.75 to 0.92 for
Discussion
The well-established associations between alcohol intake and chronic HBV or HCV infections on the risk of LC are robustly confirmed by the present study. Further evidence that coffee drinking is associated with decreased LC risk is also provided. New findings include evidence that the observed inverse coffee/cirrhosis relationship: i) is not caused by the confounding effect of education, smoking habits, and dietary patterns, which were controlled in the analyses; ii) is probably not
Selected Abbreviations and Acronyms
ANOVA = analysis of variance
CI = confidence intervals
ELISA = enzyme linked immunosorbent assay
HBsAg = Hepatitis B virus surface antigen
HBV = Hepatitis B virus
HCC = Hepato cellular carcinoma
HCV = Hepatitis C virus
LC = liver cirrhosis
LRT = likelihood ratio test
OR = odds ratio
PBC = primary biliary cirrhosis
RIBA = recombinant immunoblot assay
SIDECIR = Italian Study on Liver Cirrhosis Determinants
Acknowledgements
The authors gratefully acknowledge the helpful suggestions of Dr. Astrid Nehlig. Supports for this study came from Institute for the Scientific Information on Coffee (ISIC, Paris) and from the Italian National Research Council (CNR No. 98.03003.CT04).
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Cited by (0)
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Collaborative SIDECIR (Italian Study on Liver Cirrhosis Determinants) group: Morelli D., Moscatello M.R., Stefanini G.F. (Bologna); Chiesa R., Donato F., Tomasoni V. (Brescia); Guglielmini V., Manghisi O.G., Petruzzi J. (Castellana Grotte, Bari); Boncinelli L. (Como); Bocchia M., Ribotto P., Canevelli E. (Garbagnate, Milano); Isa L., Moriglioni M. (Gorgonzola, Milano); Sardi G.F., Monica M. (Lanzo Torinese, Torino); Fasoli, Baldacci (Legnano, Milano); Andri G., Migliosi G. (Manerbio-Leno, Brescia); Ajello A., Freni M.A., Spadaro A. (Messina); Gravina M., Longo G., Mangano C. (Messina); Silvani A., Bottelli R. (Milano); Fiorelli G., Fargion S., De Feo T. (Milano); Ascione A., De Luca M., Galeota Lanza A. (Napoli); Del Vecchio Blanco G., Federico A., Loguercio C. (Napoli); Burra P., Mioni D., Naccarato R. (Padova); Guarnone F., Pallavicini C., Vittadini G. (Pavia); Aricò S. (Torino); Salvagnini M. (Vicenza), Italy