The Effect of Caffeine and Alcohol Consumption on Liver Fibrosis

A Study of 1045 Asian Hepatitis B Patients Using Transient Elastography

Arlinking Ong; Vincent Wai-SunWong; Grace Lai-Hung Wong; Henry Lik-Yuen Chan

Liver International. 2011;31(7):1047-1053.

Results

Patient Characteristics

Overall, 22.7% of 1532 patients in this study came from primary care clinics and 77.3% were from hospital clinics. Six patients were excluded because of anti-HCV positivity, 60 patients because of unreliable LSM results and 421 as we failed to contact for phone-interview because of various reasons (e.g. changed telephone numbers or no answer despite multiple attempts). For patients we able to contact via phone, none of them refused to give verbal consent for the phone interview. A total of 1045 chronic hepatitis B patients were thus included in this study. Majority of patients were males (652, 62.4%), of which 175 (26.8%) were overweight and 210 (32.2%) were obese. Two hundred forty seven (37.9%) male patients had elevated ALT with 71% having HBV DNA of more than 4 logs copies/ml. Four hundred and ninety-nine (47.8%) patients consumed one cup of coffee or more per day, while 231 (22.1%) patients drank alcohol. Only 26 (2.5%) patients reported no intake of both coffee and alcohol. The median (IQR) daily consumption of caffeine from food and beverages was 124 (51.6–275.6) mg/day or 1 (0.4–2.0) cup of coffee/day while alcohol consumption of >20 g/day was 1.9% (Table 2). Two hundred and sixteen (20.7%) patients had LSM suggestive of advanced fibrosis.

Caffeine Intake and Liver Fibrosis

Table 3 shows the median total caffeine consumption in mg/day and the coffee cup equivalent according to different patient characteristics where there was no significant difference in caffeine consumption among those with no fibrosis and advanced fibrosis. There was no significant difference in LSM (Table 4). In addition, caffeine intake had no significant correlation with liver stiffness (r _s=0.011, P=0.722) or the Hui's index (r _s=−0.002, P=0.948). Based on LSM and the Hui's index, caffeine intake by univariate and multivariate analysis was not associated with the risk of advanced liver fibrosis (Table 5).

Alcohol Intake and Liver Fibrosis

Majority of patients (77.9%) did not consume alcohol while only 11 out of 231 patients with alcohol consumption had excessive alcohol drinking. The highest alcohol consumption per day was 88 g. Advanced fibrosis was only prevalent in 26 (18.8%) of those with mild to moderate alcohol consumption compared with 190 (21.0%) of those non-alcoholic drinkers (P=0.57).

Those who drink alcohol have significantly higher caffeine consumption than those who do not drink alcohol (Table 3). Caffeine intake had positive correlation with alcohol intake (r _s=0.167, P<0.001).

1 2 3 4

Next Section

Table 1. Caffeine content in beverages or food
Beverage or food	Caffeine content (mg per standard unit of consumption)	Units consumed per day (mean ± SD)	Proportion of caffeine consumed in the cohort (%)
Coffee (8 oz)	137	0.30 ± 0.62	20.7
Decaffeinated coffee (8 oz)	3	0.01 ± 0.12	0
Black tea (8 oz)	47	3.21 ± 5.35	75
Cola (12 oz)	46	0.12 ± 0.24	2.8
Caffeine free cola (12 oz)	0	0.00 ± 0.06	0
Chocolate bar (1 oz)	7	0.38 ± 0.71	1.3
Cocoa (8 oz)	6	0.05 ± 0.16	0.2

Table 2. Baseline characteristics of patients ( n=1045)
Characteristics
Age (years, mean ± SD)	46.5 ± 12.2
BMI (kg/m², mean ± SD)	23.1 ± 3.3
Waist circumference (cm, mean ± SD)	84.5 ± 10
Platelet [ × 10⁹/L, median (IQR)]	206 (167–250)
ALT [IU/L, median (IQR)]	41 (26–68)
HBeAg positive (%)	224 (21.4%)
HBV DNA (log copies/ml, mean ± SD)	7.82 ± 8.51
LSM [kPa, median (IQR)]	6.4 (4.9–9.1)
Caffeine per day
Overall [mg, median (IQR)]	124.0 (51.6–275.6)
Coffee-cup equivalent [median (IQR)]	1 (0.4–2.0)
Black-tea-cup equivalent [median (IQR)]	3 (1.2–5.8)
Alcohol consumption per day [g, median (IQR)]	0 (0–0)
0 g (%)	810 (77.5%)
>0–20 g (%)	215 (20.6%)
>20 g(%)	20 (1.9%)

ALT, alanine aminotransferase; BMI, body mass index; IQR, interquartile range; kPa, kilopascal; LSM, liver stiffness measurement; SD, standard deviation.

Table 3. Daily caffeine consumption according to patient characteristics ( n=1045)
Characteristics	N	Median caffeine intake (mg/day)	Coffee-cup equivalent (caffeine in mg divided by 137)	Black-tea-cup equivalent (caffeine in mg divided by 47)	P-value*
Sex
Male	652	131.5 (53.7–281.7)	1.0 (0.4–2.1)	2.9 (1.2–6.1)	0.129
Female	393	111.9 (48.0–259.4)	0.8 (0.4–1.9)	2.3 (1.2–5.5)
Age
≤45	483	113.9 (47.0–263.1)	0.8 (0.3–1.9)	2.3 (0.9–5.5)	0.163
>45	562	128.9 (56.9–282.0)	0.9 (0.4–2.1)	2.6 (1.2–6.1)
Body mass index
Normal	515	123.0 (48.9–247.7)	0.9 (0.4–1.8)	2.6 (1.2–5.2)	0.315
Overweight	253	141.9 (53.6–284.4)	1.0 (0.4–2.1)	2.9 (1.2–6.1)
Obese	277	116.7 (53.1–282.0)	0.9 (0.4–2.1)	2.6 (1.2–6.1)
Alanine aminotransferase
≤58 IU/L	715	113.7 (47.4–262.1)	0.8 (0.3–1.9)	2.3 (0.9–5.5)	0.074
>58 IU/L	330	144.1 (59.7–282.0)	1.1 (0.4–2.1)	3.2 (1.2–6.1)
HBeAg status
Positive	224	137.3 (48.9–280.8)	1.0 (0.4–2.0)	2.9 (1.2–5.8)	0.709
Negative	821	121.2 (53.1–274.7)	0.9 (0.4–2.0)	2.6 (1.2–5.8)
Alcohol consumption
No	814	113.0 (46.7–243.8)	0.8 (0.3–1.8)	2.3 (0.9–5.2)	<0.001
Yes	231	180.1 (83.0–313.1)	1.3 (0.6–2.3)	3.8 (1.7–6.7)
Liver stiffness measurement
No fibrosis	829	127.6 (48.1–282.0)	0.9 (0.4–2.1)	2.6 (1.2–6.1)	0.355
Advanced fibrosis and cirrhosis	216	111.3 (54.1–239.0)	0.8 (0.4–1.7)	2.3 (1.2–4.9)

All caffeine intakes were presented as median (interquartile range).
*P-values refer to the comparison of caffeine intake by Kruskal–Wallis's test between groups under the same characteristic (e.g. male vs. female).

Table 4. Characteristics of patients by category of caffeine consumption
	Coffee-cup equivalent of caffeine intake				P-value*
	Non-drinker	>0–1/day	>1–2/day	>2/day	P-value*
Number in cohort	27	519	237	262
Age (years, mean ± SD)	49 ± 13	46 ± 12	46 ± 13	47 ± 12	0.55
Age (years)
≤45	11 (40.7%)	246 (47.4%)	110 (46.4%)	116 (44.3%)	0.80
>45	16 (59.3%)	273 (52.6%)	127 (53.6%)	146 (55.7%)
Sex
Female	13 (3.3%)	204 (51.9%)	85 (21.6%)	91 (23.2%)	0.37
Male	14 (2.2%)	315 (48.3%)	152 (23.3%)	171 (26.2%)
Body mass index (kg/m², mean ± SD)	23.9 ± 3.3	23.1 ± 3.2	22.3 ± 8.7	24.6 ± 21.4	0.16
Body mass index
Normal	12 (44.4%)	262 (50.5%)	124 (52.3%)	117 (44.7%)	0.36
Overweight	5 (18.5%)	117 (22.5%)	60 (25.3%)	71 (27.1%)
Obese	10 (37.1%)	140 (27.0%)	53 (22.4%)	74 (28.2%)
Waist circumference (cm, mean ± SD)	86.9 ± 11.1	84.5 ± 10.1	82.8 ± 15.2	84.9 ± 9.8	0.09
Alanine aminotransferase (IU/L)	38 (21–64)	41 (26–64)	42 (25–72.5)	41 (27–72)	0.37
Alanine aminotransferase
≤58 IU/L	19 (2.7%)	371 (51.9%)	154 (21.5%)	171 (23.9%)	0.19
>58 IU/L	8 (2.4%)	148 (44.8%)	83 (25.2%)	91 (27.6%)
Albumin (g/L, mean ± SD)	44 ± 4	44 ± 4	44 ± 3	44 ± 3	0.68
Total bilirubin [μmol/L, median (IQR)]	13 (10–19)	13 (9–17)	13 (9–18)	13 (9–18)	0.58
HBeAg status
Positive	4 (1.8%)	108 (48.2%)	55 (24.6%)	57 (25.4%)	0.73
Negative	23 (2.8%)	411 (50.1%)	182 (22.2%)	205 (24.9%)
HBV DNA (log copies/ml, mean ± SD)	7.28 ± 7.98	7.91 ± 8.57	7.81 ± 8.51	7.62 ± 8.23	0.34
Liver stiffness measurement (kPa, mean ± SD)	8.0 ± 6.5	8.4 ± 6.6	8.4 ± 6.1	8.2 ± 5.5	0.95
Liver stiffness measurement
No fibrosis	24 (88.9%)	401 (77.3%)	189 (79.7%)	215 (82.1%)	0.25
Advanced fibrosis and cirrhosis	3 (11.1%)	118 (22.7%)	48 (20.3%)	47 (17.9%)
Hui's index
Unlikely to have fibrosis	20 (74.1%)	351 (67.6%)	164 (69.2%)	179 (68.3%)	0.89
With fibrosis	7 (25.9%)	168 (32.4%)	73 (30.8%)	83 (31.7%)
Alcohol consumption
No	26 (96.3%)	422 (81.3%)	181 (76.4%)	185 (70.6%)	0.001
Yes	1 (3.7%)	97 (18.7%)	56 (23.6%)	77 (29.4%)
Daily alcohol intake [g, median (IQR)]	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–1.1)	0.001

*Categorical variables were compared by χ²-test, while continuous variables were compared by Kruskal–Wallis test.
HBV, hepatitis B virus; IQR, interquartile range; SD, standard deviation.

Table 5. Relationship of caffeine intake, advanced fibrosis and alcohol consumption
	Advanced fibrosis based on liver stiffness				Significant fibrosis based on Hui's Index
	Univariate analysis		Multivariate analysis		Univariate analysis		Multivariate analysis
	Odds ratio (95% CI)	P-value	Odds ratio (95% CI)	P-value	Odds ratio (95% CI)	P-value	Odds ratio (95% CI)	P-value
Caffeine intake
Overall	1.00 (0.99–1.00)	0.544	1.00 (0.99–1.00)	0.326	1.00 (1.00–1.001)	0.197	1.00 (1.00–1.001)	0.337
Coffee	1.00 (0.99–1.00)	0.623			1.00 (1.00–1.001)	0.221
Tea	1.00 (0.98–1.00)	0.311			1.00 (0.99–1.001)	0.135
Alcohol consumption	0.99 (0.97–1.02)	0.577	0.99 (0.96–1.02)	0.496	0.99 (0.95–1.03)	0.574	0.98 (0.93–1.02)	0.317
Age	1.041 (1.03–1.05)	<0.0001	1.04 (1.03–1.06)	<0.0001	1.06 (1.05–1.08)	<0.0001	1.07 (1.05–1.09)	<0.0001
Sex (male)	1.51 (1.10–2.10)	0.011	1.33 (0.95–1.87)	0.099	1.58 (1.03–2.43)	0.038	1.39 (0.88–2.21)	0.157
ALT	1.002 (1.001–1.003)	<0.0001	1.002 (1.001–1.004)	<0.0001	1.003 (1.001–1.004)	<0.0001	1.004 (1.002–1.005)	<0.0001
BMI	1.07 (1.02–1.12)	0.004	1.04 (0.99–1.09)	0.116

ALT, alanine aminotransferase; BMI, body mass index; CI, confidence intervals.

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.