Original article
Coffee Intake and Mortality from Liver Cirrhosis

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Abstract

PURPOSE: The aim of the study was to evaluate the association between coffee consumption and mortality from liver cirrhosis.

METHODS: We conducted a mortality follow-up of 51,306 adults who underwent screening for cardiovascular disease from 1977 to 1983. During the subsequent 17 years, the total number of deaths from all causes in the studied cohort was 4207. Fifty-three had the diagnosis of cirrhosis mentioned on the death certificate; of these, 36 had alcoholic cirrhosis.

RESULTS: The relative risk of liver cirrhosis mentioned on the death certificate associated with an increase of two cups of coffee, adjusted for sex, age, alcohol use and other major cardiovascular risk factors was 0.6 (95% confidence interval, 0.5–0.8). For alcoholic cirrhosis the results were identical. When studying cirrhosis as the underlying cause of death, the inverse relationship becomes somewhat stronger.

CONCLUSIONS: The present study confirms the existence of an inverse association between coffee consumption and liver cirrhosis.

Introduction

Alcoholic beverages and coffee have been part of the human diet for centuries. Norway is well known for a restrictive alcohol policy and the total alcohol consumption is relatively low and liver cirrhosis mortality is not predominant. On the other hand Norwegians are among the highest consumers of coffee in the world (1).

Alcohol has a well-established toxic and graded effect on liver, including cirrhosis. Since most heavy drinkers do not develop alcoholic cirrhosis, it is widely believed that alcoholic cirrhosis has multiple causes and that both start and progression of the process may be dependent upon predisposing factors and other causes. It has the well known effect of raising blood concentration of the liver enzyme γ glutamyltransferase (GGT) which is widely used as a marker of alcohol intake, although it is documented that other factors also are associated with serum levels of GGT 2, 3, 4.

An inverse association between serum GGT and intake of coffee has been documented in the study of Arnesen et al. (2) in population studies in Norway. This finding has been consistently observed in population studies from other countries 3, 4, 5, 6. Attention has recently been drawn to possible beneficial effects of coffee drinking on liver diseases. A prospective study of Klatsky et al. 7, 8 reported a lower risk of hospitalization, and death from alcoholic cirrhosis in association with coffee drinking. Similar results were also observed in three case-control studies published later 9, 10, 11.

To provide further information on the issue, we utilized a cardiovascular survey in a population characterized by high coffee consumption and low risk of liver cirrhosis and did mortality follow-up with liver cirrhosis mentioned on the death certificate as endpoint.

Section snippets

Materials and methods

Between 1977 and 1983, men and women living in three counties in different parts of Norway (Finmark 1977–78, Sogn og Fjordane 1980, Oppland 1981–83) were invited to participate in a cardiovascular screening program organized by the National Health Screening Service. The screening procedures have been described in detail elsewhere 1, 12. The survey included all residents aged 40–55, and an approximately 20% random sample of men and women aged 20–39 years. Response rate was high (87% for men and

Results

Table 1 shows biologic variables and other lifestyle factors according to different levels of coffee intake. Cholesterol levels and prevalence of the current daily smoking and alcohol use increased steadily with increasing level of coffee intake.

The mortality rates were distinctly lower among persons drinking three or more cups of coffee than in those drinking two or less (Table 2). This applies to both cirrhosis and alcoholic cirrhosis as mentioned and underlying causes. For above three cups

Discussion

This study provides evidence of a favorable role of coffee intake on the risk of death from liver cirrhosis. To our knowledge, only the studies of Klatsky et al. 7, 8, Corrao et al. 9, 10 and Gallus et al. (11) have related the risk of cirrhosis to coffee intake. In the prospective study conducted in Northern California (7), an inverse coffee-cirrhosis relation was reported for the first time. Coffee drinking, but not tea drinking, was inversely related to alcoholic cirrhosis risk, with persons

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