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Higher Caffeine Consumption is associated with Milder Fibrosis in patients with Chronic Liver Diseases
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Reported by Jules Levin
AASLD, Nov 2-6, 2007, Boston, MA
caffeine intake ≥ 300 mg/day (~2.2 cups of coffee daily) was associated with reduced fibrosis compared to lesser amounts or no caffeine intake (OR=0.39, 95% CI 0.15-1.03, p=0.057). The effect of caffeine was even more pronounced in pts with HCV. HCV pts with caffeine intake ≥ 300 mg/d were 88% less likely to have advanced fibrosis than pts with lower consumption
A. A. Modi1; J. J. Feld1; Y. Park1; J. Everhart2; T. Liang1; J. H. Hoofnagle1
1. Liver Diseases Branch, NIDDK, NIH, Bethesda, MD, USA.
2. Epidemiology and Clinical Trials Branch, NIDDK, NIH, Bethesda, MD, USA.
Introduction: Two recent population-based surveys (NHANES I and III) have reported that higher caffeine consumption was associated with lower risk of elevated ALT levels and lower risk of chronic liver disease (CLD).
Aim: To develop an instrument to assess caffeine consumption and evaluate the association of caffeine intake with severity of fibrosis in pts with CLD.
Methods: A questionnaire aimed at measuring caffeine consumption over the previous month was developed and administered to all pts undergoing liver biopsy. Modified from a Nurses Health study questionnaire, it asked the frequency of consumption of caffeine-containing foods and beverages, including soft drinks, coffee, tea, cocoa as well as caffeine-fortified drinks, chocolate bars, caffeine-containing medications and alcohol intake. Caffeine consumption was quantified as the average mg of caffeine per day in which one 8 oz cup of coffee = 136 mg. Routine liver tests were obtained at the time of questionnaire completion, and liver histology was scored using a modified Ishak scoring system for activity and fibrosis. Logistic regression was performed to evaluate the association of caffeine with advanced liver fibrosis (Ishak score≥3).
Results: Among the 182 pts (60% male, 58% Caucasian, mean age 48 years), 112 had HCV, 38 HBV, 3 HDV, 21 NASH, 4 PBC and 4 AIH. 137 pts underwent liver biopsy and 30% had advanced fibrosis. The average caffeine intake was 193 mg/day (~ 1.5 cups of coffee/day). No patient reported more than minimal alcohol intake. Repeat administration of the questionnaire (> 2 weeks after initial) demonstrated consistency in reporting of caffeine intake (Cronbach coefficient alpha = 0.97). Among the entire cohort, after adjusting for other factors known to be associated with fibrosis (age, sex and baseline ALT), caffeine intake ≥ 300 mg/day (~2.2 cups of coffee daily) was associated with reduced fibrosis compared to lesser amounts or no caffeine intake (OR=0.39, 95% CI 0.15-1.03, p=0.057). The effect of caffeine was even more pronounced in pts with HCV. HCV pts with caffeine intake ≥ 300 mg/d were 88% less likely to have advanced fibrosis than pts with lower consumption both by univariate and multivariate regression (adjusted OR=0.22, 95% CI 0.06-0.89, p= 0.03). Higher caffeine consumption was also independently associated with ALT values below the median (58 IU/l) for the HCV cohort (OR=0.37 95% CI 0.15-0.92, p=0.03).
Conclusions: Higher caffeine consumption is associated with milder fibrosis in pts with CLD, particularly those with HCV infection.
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