COMMENTARY

Coffee May Increase Life Expectancy in Liver Disease

Rowen K. Zetterman, MD

Disclosures

November 07, 2017

Slows Fibrosis of NAFLD

Metabolic syndrome, a known contributor to NAFLD associated with type 2 diabetes mellitus, abdominal obesity, systemic hypertension, and hyperlipidemia, is present in nearly 30% of the US population.[21] A recent meta-analysis of 11 relevant publications suggested that coffee consumption can reduce occurrence of metabolic syndrome.[22]

The relationship between coffee and the reduction of fatty liver disease is less clear, however. Some studies suggest no effect from coffee, whereas others have indicated coffee can reduce occurrence of fatty liver.[23,24,25] One recent study evaluated the relationship between coffee and the presence of nonalcoholic steatohepatitis (NASH) when liver biopsy histology was obtained from 112 patients undergoing bariatric surgery.[26] Although less steatohepatitis was noted in those with greater coffee intake, no statistical association between increased coffee intake and the presence or absence of NASH was proven.

In other studies, coffee reduced the development of fibrosis and/or cirrhosis in NAFLD.[19] This effect of coffee on fibrosis development has also been noted in patients with alcoholic liver disease and chronic hepatitis C, but not chronic hepatitis B. Whereas most studies have found no reduction in risk for NAFLD by coffee, there is an associated reduction in fibrosis among patients with NAFLD.[27,28,29,30]

Reduces the Risk for Hepatocellular Carcinoma

Systematic reviews and meta-analyses continue to show a strong association between coffee intake and reduction in the risk of developing hepatocellular carcinoma.[31,32,33,34,35,36,37] This risk reduction is evident in both persons with preexisting liver disease and those without known liver disease.[32] The dose/response effect of increased coffee intake occurs in both men and women,[34] although one study suggested a greater risk reduction by coffee in women.[37] The preventive effect of coffee seems unrelated to geographic factors.

Whether decaffeinated coffee is as effective as caffeinated coffee in reducing liver cancer risk is less clear.[35,36,37] Other compounds also present in both regular and decaffeinated coffee might also affect factors that influence liver carcinoma risk; these compounds include aflatoxin and inflammatory biomarkers, such as interleukin-6,[38] interleukin-18,[39] and C-reactive protein.[40]

Coffee does not appear to affect the development of cholangiocarcinoma.[37]

Summary

NAFLD continues to increase in prevalence as a cause of end-stage liver disease in the United States, affecting American adults, children, and teenagers. We seem unable to reduce the development of NAFLD among our patients, and effective medication treatments are not yet available.

The growing volume of data on coffee indicates its ability to reduce the development of fibrosis, especially in patients with fatty liver. So as these studies accumulate, is it time to recommend two or more cups of coffee daily for persons with NAFLD? Must it be caffeinated? Is the evidence for decaffeinated coffee strong enough to say that either is acceptable? These data and those supporting the reduction of all-cause mortality with coffee intake indicate that it may be time to recommend coffee as part of a healthy diet. So, drink up.

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