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Prescription 2015: Coffee for Liver Health

April 27, 2015 Written by JP    [Font too small?]

If you put any given food under the microscope, you’ll typically find some good elements and some not so great things. The proportions of each vary, but a mixture of both is to be expected. Coffee presents a fitting example of this gastronomic truism. On the one hand, some health authorities point to the supposed dark side of java. They note that coffee may contribute to and/or instigate cardiovascular complications, gastrointestinal symptoms, poor bone density and sleep disorders. On the flip side, coffee’s proponents proclaim that it’s one the leading sources of antioxidants in the modern diet. This inconvenient reality may explain why coffee drinking populations tend to demonstrate a lower risk for a number of diseases, including dementia and select cancers.

In the past, the most common relationship between coffee intake and liver health had to do with the beverage’s role in hangover recovery. That was then, this is now. In recent years, even the most conservative, peer-reviewed medical journals have concluded that coffee confers a number of benefits pertaining to chronic liver diseases. The November-December 2014 issue of the Journal of Clinical Gastroenterology reports that coffee: “has been inversely associated with activity of liver enzymes in subjects at risk, including heavy drinkers”; “favors an improvement in hepatic steatosis and fibrosis, and a reduction in cirrhosis and the risk of hepatocellular carcinoma”; “promotes antioxidant capacity through an increase in glutathione as well as modulation of the gene and protein expression of several inflammatory mediators” and much, much more.

The research summarized in the previously mentioned review has been strengthened by subsequent publications in the medical literature. Additionally, there’s emerging evidence that coffee could play a vital role in protecting against NAFLD aka nonalcoholic fatty liver disease. NAFLD affects roughly half of those diagnosed with adult onset diabetes and nearly as many type 1 diabetics. As its name implies, NAFLD is characterized by a build up of fat in the liver. As the disease progresses, it causes inflammation and scarring which, if not properly addressed, can lead to cirrhosis of the liver. Thankfully, three trials published in 2014 and 2015 offer hope to all those who are at risk for diabetes and related conditions. The first study revealed that coffee consumers had reduced fasting and post meal blood glucose, HbA1c (a long term measure of blood glucose) and increased adiponectin – an anti-inflammatory protein that tends to be higher in non-diabetics. The second specifically found an association between coffee drinking and lower levels of fetuin-A and y-glutamyltransferase, key markers of liver function and health. The final experiment examined the impact of coffee on liver related changes caused by fructose overfeeding. Three different types of coffee were put to the test in a small group of healthy volunteers – caffeinated coffee, caffeinated coffee high in chlorogenic acid and decaffeinated coffee. Each of the three coffees attenuated fructose induced, hepatic insulin resistance. This suggests that drinking coffee in the context of a less-than-optimal diet may safeguard against liver dysfunction.

All told, this new batch of research further clarifies and supports the role of coffee in shielding against diabetes and liver disease. This is something about which we should all be mindful.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – Coffee and Liver Health (link)

Study 2 – Coffee and Caffeine Are Associated w/ Decreased Risk of Advanced (link)

Study 3 – Coffee Consumption and Nonalcoholic Fatty Liver Onset: A (link)

Study 4 – Association of Coffee Intake w/ Reduced Incidence of Liver Cancer (link)

Study 5 – Coffee, Tea and Decaffeinated Coffee in Relation to Hepatocellular (link)

Study 6 – Inverse Associations of Total and Decaffeinated Coffee w/ Liver Enzyme (link)

Study 7 – Coffee, Alcohol and Other Beverages in Relation to Cirrhosis Mortality (link)

Study 8 – Relationship of Caffeine w/ Adiponectin & Blood Sugar Levels in (link)

Study 9 – Evaluation of Various Biomarkers as Potential Mediators of the (link)

Study 10 – Coffee Consumption Attenuates Short-Term Fructose-Induced Liver (link)

Coffee May Reduce Liver Dysfunction in a Dose Dependent Manner

Source: Alcohol Alcohol. 2013 May-Jun;48(3):303-7. (link)

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Posted in Alternative Therapies, Diabetes, Food and Drink

26 Comments & Updates to “Prescription 2015: Coffee for Liver Health”

  1. JP Says:

    Update 04/27/15:


    Nutr J. 2015 Mar 15;14(1):26.

    Dietary antioxidant capacity of the patients with cardiovascular disease in a cross-sectional study.

    BACKGROUND: The purpose of this study was to establish sources and patterns of antioxidant, polyphenol and flavonoid intakes in men and women with cardiovascular disease (CVD).

    METHODS: The subjects with CVD and healthy controls (HC) were participants of the Polish National Multicenter Health Survey (WOBASZ). Food intakes were measured with the 1-day 24-hour recall method. A self-developed database was used to calculate dietary total antioxidant capacity (DTAC), dietary total polyphenol content (DTPC) and dietary total flavonoid content (DTFC).

    RESULTS: DTAC did not differ between the men with CVD and HC men (6442 vs. 6066 μmol trolox equivalents – TE), but in the women with CVD it was significantly higher than in the HC women (6182 vs. 5500 μmol TE). The main sources of antioxidants in the males with CVD were: tea, coffee, apples, and nuts and seeds, and tea, coffee and apples in HC. In the females they were: tea, coffee, apples and strawberries, both in the women with CVD and HC. DTPC in the men with CVD did not differ from HC (1198 vs. 1114 mg gallic acid equivalents, GAE). In the females, DTPC was significantly higher in the subjects with CVD as compared to HC (1075 vs. 981 mg GAE). Predominant sources of polyphenols were: tea, coffee, cabbage, potatoes, apples and white bread in the men with CVD, and tea, coffee, potatoes, white bread and apples in HC, while in the women (both with CVD and HC): tea, coffee, apples, potatoes and cabbage. No differences in DTFC have been found between the males with CVD and HC (212 vs. 202 mg quercetine equivalents, QE). In the women with CVD, DTFC was significantly higher than in HC (200 vs. 177 mg QE). Main sources of flavonoids in all participants (men and women, CVD and HC) were tea, apples, cabbage and coffee.

    CONCLUSIONS: Polish men and women faced with CVD beneficially modify their dietary practices by enhancing intakes of foods that are sources of antioxidants, polyphenols and flavonoids. Different sources and patterns of antioxidant, polyphenol and flavonoid intakes, however, between male and female patients with CVD were observed.

    Be well!


  2. JP Says:

    Update 04/27/15:


    Am J Clin Nutr. 2015 Mar 11.

    Association of coffee intake with total and cause-specific mortality in a Japanese population: the Japan Public Health Center-based Prospective Study.

    BACKGROUND: Despite the rising consumption of coffee worldwide, few prospective cohort studies assessed the association of coffee intake with mortality including total and major causes of death.

    OBJECTIVE: We aimed to investigate the association between habitual coffee drinking and mortality from all causes, cancer, heart disease, cerebrovascular disease, respiratory disease, injuries, and other causes of death in a large-scale, population-based cohort study in Japan.

    DESIGN: We studied 90,914 Japanese persons aged between 40 and 69 y without a history of cancer, cerebrovascular disease, or ischemic heart disease at the time of the baseline study. Subjects were followed up for an average of 18.7 y, during which 12,874 total deaths were reported. The association between coffee intake and risk of total and cause-specific mortality was assessed by using a Cox proportional hazards regression model with adjustment for potential confounders.

    RESULTS: We showed an inverse association between coffee intake and total mortality in both men and women. HRs (95% CIs) for total death in subjects who consumed coffee compared with those who never drank coffee were 0.91 (0.86-0.95) for <1 cup/d, 0.85 (0.81-0.90) for 1-2 cups/d, 0.76 (0.70-0.83) for 3-4 cups/d, and 0.85 (0.75-0.98) for >5 cups/d (P-trend < 0.001). Coffee was inversely associated with mortality from heart disease, cerebrovascular disease, and respiratory disease. CONCLUSION: With this prospective study, we suggest that the habitual intake of coffee is associated with lower risk of total mortality and 3 leading causes of death in Japan. Be well! JP

  3. JP Says:

    Update 04/27/15:


    Heart. 2015 May 1;101(9):686-91.

    Coffee consumption and coronary artery calcium in young and middle-aged asymptomatic adults.

    OBJECTIVE: To investigate the association between regular coffee consumption and the prevalence of coronary artery calcium (CAC) in a large sample of young and middle-aged asymptomatic men and women.

    METHODS: This cross-sectional study included 25 138 men and women (mean age 41.3 years) without clinically evident cardiovascular disease who underwent a health screening examination that included a validated food frequency questionnaire and a multidetector CT to determine CAC scores. We used robust Tobit regression analyses to estimate the CAC score ratios associated with different levels of coffee consumption compared with no coffee consumption and adjusted for potential confounders.

    RESULTS: The prevalence of detectable CAC (CAC score >0) was 13.4% (n=3364), including 11.3% prevalence for CAC scores 1-100 (n=2832), and 2.1% prevalence for CAC scores >100 (n=532). The mean ±SD consumption of coffee was 1.8±1.5 cups/day. The multivariate-adjusted CAC score ratios (95% CIs) comparing coffee drinkers of <1, 1-<3, 3-<5, and ≥5 cups/day to non-coffee drinkers were 0.77 (0.49 to 1.19), 0.66 (0.43 to 1.02), 0.59 (0.38 to 0.93), and 0.81 (0.46 to 1.43), respectively (p for quadratic trend=0.02). The association was similar in subgroups defined by age, sex, smoking status, alcohol consumption, status of obesity, diabetes, hypertension, and hypercholesterolaemia.

    CONCLUSIONS: In this large sample of men and women apparently free of clinically evident cardiovascular disease, moderate coffee consumption was associated with a lower prevalence of subclinical coronary atherosclerosis.

    Be well!


  4. G. Paul F. Says:

    Hi JP,
    Great news for Starbucks and us coffee lovers.
    Thank you!

  5. JP Says:

    Always happy to support coffee lovers and Starbucks, Paul! 😉

    Be well!


  6. Calvin Says:

    Hey JP,

    I’m a coffee lover, and this case study sure put my mind at ease. Just remember to take everything in moderation 🙂

  7. JP Says:

    Hi, Calvin.

    The key with coffee (and most beverages and foods) is to establish your tolerance and base intake on your given circumstances. For instance, I generally have no problem with a healthy adult enjoying several cups of coffee a day … if they do well with that “dosage”. However, I would take issue with an insomniac or pregnant women using coffee in that same manner. The bottom line is that we’re all individuals and ought to base our health decisions on our unique needs.

    Be well!


  8. JP Says:

    Update 04/29/15:


    PLoS One. 2015 Apr 28;10(4):e0123547.

    Role of Caffeine Intake on Erectile Dysfunction in US Men: Results from NHANES 2001-2004.

    OBJECTIVES: Caffeine is consumed by more than 85% of adults and little is known about its role on erectile dysfunction (ED) in population-based studies. We investigated the association of caffeine intake and caffeinated beverages with ED, and whether these associations vary among comorbidities for ED.

    MATERIAL AND METHOD: Data were analyzed for 3724 men (≥20 years old) who participated in the National Health and Nutrition Examination Survey (NHANES). ED was assessed by a single question during a self-paced, computer-assisted self-interview. We analyzed 24-h dietary recall data to estimate caffeine intake (mg/day). Multivariable logistic regression analyses using appropriate sampling weights were conducted.

    RESULTS: We found that men in the 3rd (85-170 mg/day) and 4th (171-303 mg/day) quintiles of caffeine intake were less likely to report ED compared to men in the lowest 1st quintile (0-7 mg/day) [OR: 0.58; 95% CI, 0.37-0.89; and OR: 0.61; 95% CI, 0.38-0.97, respectively], but no evidence for a trend. Similarly, among overweight/obese and hypertensive men, there was an inverse association between higher quintiles of caffeine intake and ED compared to men in the lowest 1st quintile, P≤0.05 for each quintile. However, only among men without diabetes we found a similar inverse association (Ptrend = 0.01).

    CONCLUSION: Caffeine intake reduced the odds of prevalent ED, especially an intake equivalent to approximately 2-3 daily cups of coffee (170-375 mg/day). This reduction was also observed among overweight/obese and hypertensive, but not among diabetic men. Yet, these associations are warranted to be investigated in prospective studies.

    Be well!


  9. ben Says:

    I go all in with coffee!

    What are your thoughts on the recent ‘bulletproof’ trend, that adds tbsps of mct (coconut) oil and butter to the morning cup of joe?

    Not sure if greek/turkish coffee is any different but I like to top the last inch or so of my regular coffee (french pressed healthy bean) with greek coffee followed by a couple of Life Extension CoffeeGenic Green Coffee Extract pills 400mg!

  10. JP Says:

    Hi, Ben.

    My goodness! You are a coffee lover! 🙂

    Certainly, Bulletproof Coffee is a hot trend. To the best of my knowledge, there isn’t much scientific evidence demonstrating it’s superiority. However, there appears to be a study in the works that should help to clarify this:


    All three of the ingredients in BC possess real world health benefits. But, what isn’t known is whether the combination is more potent than the sum of it’s parts. Below, I’ll link to a pretty good summary:


    Lastly, I recommend organic (unrefined/virgin) coconut oil over MCT oil. So, if I were to make it for myself, that’s what I’d use.

    Be well!


  11. JP Says:

    Update 05/19/15:


    PLoS One. 2015 May 15;10(5):e0126469.

    Coffee Consumption, Newly Diagnosed Diabetes, and Other Alterations in Glucose Homeostasis: A Cross-Sectional Analysis of the Longitudinal Study of Adult Health (ELSA-Brasil).

    INTRODUCTION: Observational studies have reported fairly consistent inverse associations between coffee consumption and risk of type 2 diabetes, but this association has been little investigated with regard to lesser degrees of hyperglycemia and other alterations in glucose homeostasis. Additionally, the association between coffee consumption and diabetes has been rarely investigated in South American populations. We examined the cross-sectional relationships of coffee intake with newly diagnosed diabetes and measures of glucose homeostasis, insulin sensitivity, and insulin secretion, in a large Brazilian cohort of middle-aged and elderly individuals.

    METHODS: We used baseline data from 12,586 participants of the Longitudinal Study of Adult Health (ELSA-Brasil). Logistic regression analyses were performed to examine associations between coffee consumption and newly diagnosed diabetes. Analysis of covariance was used to assess coffee intake in relation to two-hour glucose from an oral glucose tolerance test, fasting glucose, glycated hemoglobin, fasting and -2-hour postload insulin and measures of insulin sensitivity.

    RESULTS: We found an inverse association between coffee consumption and newly diagnosed diabetes, after adjusting for multiple covariates [23% and 26% lower odds of diabetes for those consuming coffee 2-3 and >3 times per day, respectively, compared to those reporting never or almost never consuming coffee, (p = .02)]. An inverse association was also found for 2-hour postload glucose [Never/almost never: 7.57 mmol/L, ≤1 time/day: 7.48 mmol/L, 2-3 times/day: 7.22 mmol/L, >3 times/day: 7.12 mol/L, p<0.0001] but not with fasting glucose concentrations (p = 0.07). Coffee was additionally associated with 2-hour postload insulin [Never/almost never: 287.2 pmol/L, ≤1 time/day: 280.1 pmol/L, 2-3 times/day: 275.3 pmol/L, >3 times/day: 262.2 pmol/L, p = 0.0005) but not with fasting insulin concentrations (p = .58).

    CONCLUSION: Our present study provides further evidence of a protective effect of coffee on risk of adult-onset diabetes. This effect appears to act primarily, if not exclusively, through postprandial, as opposed to fasting, glucose homeostasis.

    Be well!


  12. JP Says:

    Update 05/23/15:


    Cancer Epidemiol Biomarkers Prev. 2015 May 21.

    Associations of coffee drinking with systemic immune and inflammatory markers.

    BACKGROUND: Coffee drinking has been inversely associated with mortality as well as cancers of the endometrium, colon, skin, prostate, and liver. Improved insulin sensitivity and reduced inflammation are among the hypothesized mechanisms by which coffee drinking may affect cancer risk; however, associations between coffee drinking and systemic levels of immune and inflammatory markers have not been well characterized.

    METHODS: We used Luminex bead-based assays to measure serum levels of 77 immune and inflammatory markers in 1,728 older non-Hispanic Whites. Usual coffee intake was self-reported using a food frequency questionnaire. We used weighted multivariable logistic regression models to examine associations between coffee and dichotomized marker levels. We conducted statistical trend tests by modeling the median value of each coffee category and applied a 20% false discovery rate criterion to P-values.

    RESULTS: Ten of the 77 markers were nominally associated (P-value for trend<0.05) with coffee drinking. Five markers withstood correction for multiple comparisons and included aspects of the host response namely chemotaxis of monocytes/macrophages (IFNγ, CX3CL1/fractalkine, CCL4/MIP-1β), pro-inflammatory cytokines (sTNFRII) and regulators of cell growth (FGF-2). Heavy coffee drinkers had lower circulating levels of IFNγ (OR=0.35; 95% CI 0.16-0.75), CX3CL1/fractalkine (OR=0.25; 95% CI 0.10-0.64), CCL4/MIP-1β (OR=0.48; 95% CI 0.24-0.99), FGF-2 (OR=0.62; 95% CI 0.28-1.38), and sTNFRII (OR=0.34; 95% CI 0.15-0.79) than non-coffee drinkers.

    CONCLUSIONS: Lower circulating levels of inflammatory markers among coffee drinkers may partially mediate previously observed associations of coffee with cancer and other chronic diseases.

    IMPACT: Validation studies, ideally controlled feeding trials, are needed to confirm these associations.

    Be well!


  13. JP Says:

    Update 06/01/15:


    Nutr Metab Cardiovasc Dis. 2015 Apr 25.

    A double-blind, placebo-controlled randomized trial to evaluate the efficacy of docosahexaenoic acid supplementation on hepatic fat and associated cardiovascular risk factors in overweight children with nonalcoholic fatty liver disease.

    BACKGROUND AND AIMS: Very little information is available on whether docosahexaenoic acid (DHA) supplementation has a beneficial effect on liver fat and cardiovascular disease (CVD) risk factors in children with nonalcoholic fatty liver disease (NAFLD). In a double-blind, placebo-controlled randomized trial we investigated whether 6-month treatment with DHA improves hepatic fat and other fat depots, and their associated CVD risk factors in children with biopsy-proven NAFLD.

    METHODS AND RESULTS: Of 58 randomized children, 51 (25 DHA, 26 placebo) completed the study. The main outcome was the change in hepatic fat fraction as estimated by magnetic resonance imaging. Secondary outcomes were changes in visceral adipose tissue (VAT), epicardial adipose tissue (EAT), and left ventricular (LV) function, as well as alanine aminotransferase (ALT), triglycerides, body mass index-standard deviation score (BMI-SDS), and insulin sensitivity. At 6 months, the liver fat was reduced by 53.4% (95% CI, 33.4-73.4) in the DHA group, as compared with 22.6% (6.2-39.0) in the placebo group (P = 0.040 for the comparison between the two groups). Likewise, in the DHA group VAT and EAT were reduced by 7.8% (0-18.3) and 14.2% (0-28.2%), as compared with 2.2% (0-8.1) and 1.7% (0-6.8%) in the placebo group, respectively (P = 0.01 for both comparisons). There were no significant between-group changes for LV function as well as BMI-SDS and ALT, while fasting insulin and triglycerides significantly decreased in the DHA-treated children (P = 0.028 and P = 0.041, respectively).

    CONCLUSIONS: DHA supplementation decreases liver and visceral fat, and ameliorates metabolic abnormalities in children with NAFLD.

    Be well!


  14. JP Says:

    Update 06/30/15:


    Cancer Epidemiology, Biomarkers & Prevention Published Online First June 30, 2015

    Coffee consumption and risk of hepatocellular carcinoma and intrahepatic cholangiocarcinoma by sex: The Liver Cancer Pooling Project

    Background: Coffee consumption has been reported to be inversely associated with hepatocellular carcinoma (HCC), the most common type of liver cancer. Caffeine has chemopreventive properties, but whether caffeine is responsible for the coffee-HCC association is not well studied. In addition, few studies have examined the relationship by sex, and no studies have examined whether there is an association between coffee and intrahepatic cholangiocarcinoma (ICC), the second most common type of liver cancer.

    Methods: In the Liver Cancer Pooling Project, a consortium of U.S.-based cohort studies, data from 1,212,893 individuals (HCC n=860, ICC n=260) in nine cohorts were pooled. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CI) were estimated using proportional hazards regression.

    Results: Higher coffee consumption was associated with lower risk of HCC (HR>3 cups/day vs. non-drinker, 0.73; 95% CI, 0.53-0.99; ptrend cups/day=<0.0001). More notable reduced risk was seen among women than men (pinteraction=0.07). Women who consumed more than three cups of coffee per day were at a 54% lower risk of HCC (HR, 0.46; 95% CI, 0.26-0.81), whereas men had more modest reduced risk of HCC (HR, 0.93; 95% CI, 0.63-1.37). The associations were stronger for caffeinated coffee (HR>3 cups/day vs. non-drinker, 0.71, 95% CI, 0.50-1.01) than decaffeinated coffee (HR, 0.92; 95% CI, 0.55-1.54). There was no relationship between coffee consumption and ICC.

    Conclusions: These findings suggest that, in a U.S. population, coffee consumption is associated with reduced risk of HCC. Impact: Further research into specific coffee compounds and mechanisms that may account for these associations is needed.

    Be well!


  15. JP Says:

    Update 07/14/15:


    MMW Fortschr Med. 2014 Dec 15;156 Suppl 4:120-6.

    [Effect of silymarin on liver health and quality of life. Results of a non-interventional study].

    BACKGROUND: Many drugs are known to have hepatotoxic side effects. The effect of silymarin on liver function and liver-injury-impaired quality of life under daily practice conditions in patients with elevated values of liver enzymes was evaluated in the present non-interventional study.

    METHOD: Patients with drug-induced elevated aminotransferase levels and indication for silymarin (Legalon forte) treatment for 2 to 3 months were documented prospectively over 4 months. At baseline, after 2 and 4 months, respectively, the following parameters were documented: alanine transaminase (ALT), aspartate transaminase (AST), γ-glutamyltransferase (GGT), alkaline phosphatase, total bilirubin, presence of liver-related skin symptoms and discoloured urine, severity of liver-related symptoms and quality of life.

    RESULTS: In total, 190 patients (53.2% male, median age 60.0 years [range 19-81]) from 48 centres participated in the non-interventional study. Among potentially hepatotoxic drugs, analgesics/anti-inflammatory drugs were used most frequently (45.8%). These drugs have been administered for a median period of 2.8 years (range 0.0-26.1). At baseline, all patients had elevated levels of ALT, AST or GGT. Fatigue, flatulence, upper abdominal discomfort, lethargy, and joint complaints were the most severe liver-related symptoms and prevalent in over 62% of patients. Quality of life was affected in 88.7% of patients. Significant reductions were achieved in all documented laboratory parameters (p < 0.001), leading to marked improvement in liver-related symptoms and increased quality of life already after 2 months. The percentage of patients with liver enzymes in the normal range increased considerably within 4 months. No adverse drug reactions were observed. CONCLUSIONS: Silymarin is a safe and efficacious treatment option for patients with elevated liver enzymes. A benefit in terms of liver-related symptoms as well as quality of life and performance was demonstrated already after 2 months of treatment. Be well! JP

  16. JP Says:

    Updated 07/30/15:


    BMC Gastroenterol. 2015 Jul 28;15(1):88.

    Associations of coffee consumption with markers of liver injury in the insulin resistance atherosclerosis study.

    BACKGROUND: Coffee consumption has been associated with reduced risk of developing type 2 diabetes mellitus (T2DM) however, the mechanism for this association has yet to be elucidated. Non-alcoholic fatty liver disease (NAFLD) characterizes and predicts T2DM yet the relationship of coffee with this disorder remains unclear. Our aim was to investigate the associations of coffee with markers of liver injury in 1005 multi-ethnic, non-diabetic adults in the Insulin Resistance Atherosclerosis Study.

    METHODS: Dietary intake was assessed using a validated 114-item food frequency questionnaire. Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and fetuin-A were determined in fasting blood samples and the validated NAFLD liver fat score was calculated. Multivariate linear regression assessed the contribution of coffee to variation in markers of liver injury.

    RESULTS: Caffeinated coffee showed significant inverse associations with ALT (β = -0.08, p = 0.0111), AST (β = -0.05, p = 0.0155) and NAFLD liver fat score (β = -0.05, p = 0.0293) but not with fetuin-A (β = 0.04, p = 0.17). When the highest alcohol consumers were excluded, these associations remained (ALT β = -0.11, p = 0.0037; AST β = -0.05, p = 0.0330; NAFLD liver fat score β = -0.06, p = 0.0298). With additional adjustment for insulin sensitivity, the relationship with ALT remained significant (ALT β = -0.08, p = 0.0400; AST β = -0.03, p = 0.20; NAFLD liver fat score β = -0.03, p = 0.27). There were no significant associations of decaffeinated coffee with liver markers.

    CONCLUSIONS: These analyses indicate a beneficial impact of caffeinated coffee on liver morphology and/or function, and suggest that this relationship may mediate the well-established inverse association of coffee with risk of T2DM.

    Be well!


  17. JP Says:

    Updated 1/19/16:


    Therap Adv Gastroenterol. 2016 Jan;9(1):113-20.

    Association between caffeine consumption and nonalcoholic fatty liver disease: a systemic review and meta-analysis.

    OBJECTIVES: Caffeine consumption is reported to be associated with reduced hepatic fibrosis in patients with chronic liver diseases. We performed a systematic review and meta-analysis to assess the association between caffeine consumption and prevalence or hepatic fibrosis of nonalcoholic fatty liver disease (NAFLD) in observational studies.

    METHODS: We searched the literature of all languages from PubMed, EMBASE, and the Cochrane library from 1 January 1980 through 10 January 2015. Total caffeine consumption was defined as the daily intake of caffeine (mg/day) from all caffeine-containing products. Combined and subgroup analyses stratified by study designs, study locations, and type of caffeine intake were performed.

    RESULTS: Four cross-sectional and two case control studies with a total of 20,064 subjects were included in the meta-analysis. Among these, three studies with 18,990 subjects were included in the analysis for prevalence of NAFLD while the other three studies with 1074 subjects were for hepatic fibrosis. Total caffeine consumption (mg/day) was not significantly associated with either the prevalence [pooled mean difference (MD) 2.36; 95% confidence interval (CI) -35.92 to 40.64] or hepatic fibrosis (higher versus lower stages; pooled MD -39.95; 95% CI -132.72 to 52.82) of NAFLD. Subgroup analyses stratified by study designs and locations were also not significant. However, after stratifying by type of caffeine intake, regular coffee caffeine intake (mg/day) was significantly associated with reduced hepatic fibrosis of NAFLD (pooled MD -91.35; 95% CI -139.42 to -43.27; n = 2 studies).

    CONCLUSION: Although total caffeine intake is not associated with the prevalence or hepatic fibrosis of NAFLD, regular coffee caffeine consumption may significantly reduce hepatic fibrosis in patients with NAFLD.

    Be well!


  18. JP Says:

    Updated 1/28/16:


    Int J Obes (Lond). 2016 Jan 20.

    Strong and persistent effect on liver fat with a Paleolithic diet during a two-year intervention.

    BACKGROUND/OBJECTIVES: Our objective was to investigate changes in liver fat and insulin sensitivity during a 2-year diet intervention. An ad libitum Paleolithic diet was compared to a conventional, low-fat diet.

    SUBJECTS/METHODS: Seventy healthy, obese, postmenopausal women were randomized to either a Paleolithic diet or a conventional, low-fat diet. Diet intakes were ad libitum. Liver fat was measured with proton magnetic resonance spectroscopy. Insulin sensitivity was evaluated with oral glucose tolerance tests and calculated as HOMA-IR/Liver IR index for hepatic insulin sensitivity and OGIS/Matsuda for peripheral insulin sensitivity. All measurements were performed at 0, 6, and 24 months. 41 women completed the examinations for liver fat and were included.

    RESULTS: Liver fat decreased after 6 months by 64% (95% CI: 54-74%) in the Paleolithic diet group and by 43% (27-59%) in the low-fat diet group (P<0.01 for difference between groups). After 24 months liver fat decreased 50% (25-75%) in the Paleolithic diet group and 49% (27-71%) in the low-fat diet group. Weight reduction between baseline and 6 months was correlated to liver fat improvement in the low-fat diet group (rs=0.66, P<0.01) but not in the Paleolithic diet group (rs=0.07, P=0.75). Hepatic insulin sensitivity improved during the first 6 months in the Paleolithic diet group (P<0.001 for Liver IR index and HOMA-IR), but deteriorated between 6 and 24 months without association to liver fat changes.

    CONCLUSIONS: A Paleolithic diet with ad libitum intake had a significant and persistent effect on liver fat and differed significantly from a conventional low-fat diet at six months. This difference may be due to food quality, e.g. a higher content of mono- and polyunsaturated fatty acids in the Paleolithic diet. Changes in liver fat did not associate to alterations in insulin sensitivity.

    Be well!


  19. JP Says:

    Updated 03/14/16:


    Int J Prev Med. 2016 Feb 1;7:28.

    The Effect of Green Tea Extract Supplementation on Liver Enzymes in Patients with Nonalcoholic Fatty Liver Disease.

    BACKGROUND: Green tea is one of the most popular beverages in the world. It is believed to have beneficial effects in the prevention and treatment of many diseases, one of which is nonalcoholic fatty liver disease (NAFLD). The present study investigated the effects of consumption of green tea in NAFLD patients.

    METHODS: This study was a double-blind, placebo-controlled, randomized clinical trial. Ultrasonography was used to diagnose fatty liver in patients with alanine aminotransferase (ALT) >31 mg/dl and 41 mg/dl and aspartate aminotransferase (AST) >31 mg/dl and 47 g/dl in women and men, respectively and without other hepatic diseases. A total of 80 participants (20-50 years) with NAFLD were randomly allocated into two groups to receive either green tea extract (GTE) supplement (500 mg GTE tablet per day) or placebo for 90 days. At baseline and at the end of the intervention weight, serum ALT, AST, and alkaline phosphatase (ALP) were measured in fasting state, and dietary data were collected at baseline and end of the study.

    RESULTS: Green tea group showed significant reductions in ALT and AST levels after 12 weeks period (P < 0.001). The placebo group showed a reduction in ALT and AST levels at the end of the study, but it was no significant. ALP levels showed significant reductions in both groups after 12 weeks period (P < 0.001). CONCLUSIONS: According to the findings of this study, GTE supplementation decrease liver enzymes in patients with NAFLD. It can be claimed that GTE prescribed can be considered as a treatment to improve serum levels of liver enzymes in NAFLD patients. Be well! JP

  20. JP Says:

    Updated 03/27/16:


    J Gastroenterol Hepatol. 2016 Feb 15. doi:

    Coffee consumption protects against progression in liver cirrhosis and increases long-term survival after liver transplantation.

    BACKGROUND: Therapeutic options to treat progression of end-stage liver disease (ESLD) or improve long-term survival after liver transplantation remain scarce. We investigated the impact of coffee consumption under these conditions.

    METHODS: We recorded coffee consumption habits of 379 patients with ESLD awaiting liver transplantation and 260 patients after liver transplantation. Survival was analyzed based on coffee intake.

    RESULTS: 195 patients with ESLD consumed coffee on a daily basis, while 184 patients did not. Actuarial survival was impaired (p = 0.041) in non-coffee drinkers (40.4 ± 4.3 months, 95% CI: 32.0-48.9) compared to coffee drinkers (54.9 ± 5.5 months, 95% CI: 44.0-65.7). In subgroup analysis, the survival of patients with alcoholic liver disease (ALD; p = 0.020) and primary sclerosing cholangitis (PSC; p = 0.017) was increased with coffee intake, while unaffected in patients with chronic viral hepatitis (p = 0.517) or other liver disease entities (p = 0.652). Multivariate analysis showed that coffee consumption of PSC and ALD patients retained as an independent risk factor (OR: 1.94; 95% CI: 1.15-3.28; p = 0.013) along with MELD-Score (OR: 1.13; 95% CI: 1.09-1.17; p = 0.000). Following liver transplantation, long-term survival was longer in coffee drinkers (coffee: 61.8 ± 2.0 months, 95% CI: 57.9-65.8) than non-drinkers (52.3 ± 3.5 months, 95% CI: 45.4-59.3; p = 0.001).

    CONCLUSIONS: Coffee consumption delayed disease progression in ALD and PSC patients with ESLD and increased long-term survival after liver transplantation. We conclude that regular coffee intake might be recommended for these patients.

    Be well!


  21. JP Says:

    Updated 04/11/16:


    Clin Nutr. 2016 Mar 30.

    Coffee and tea consumption in relation with non-alcoholic fatty liver and metabolic syndrome: A systematic review and meta-analysis of observational studies.

    BACKGROUND & AIMS: Diet plays a role in the onset and progression of metabolic disorders, including non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS). We aimed to systematically review and perform quantitative analyses of results from observational studies on coffee/tea consumption and NAFLD or MetS.

    METHODS: A Medline and Embase search was performed to retrieve articles published up to March 2015. We used a combination of the keywords “coffee”, “caffeine”, “tea”, “non-alcoholic fatty liver disease”, “non-alcoholic steatohepatitis”, “metabolic syndrome”. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated by random-effects model.

    RESULTS: Seven studies assessed coffee consumption in NAFLD patients. Fibrosis scores were reported in four out of seven; all four studies revealed an inverse association of coffee intake with fibrosis severity, although the lack of comparable exposure and outcomes did not allow to perform pooled analysis. Seven studies met the inclusion criteria to be included in the meta-analysis on coffee consumption and MetS. Individuals consuming higher quantities of coffee were less like to have MetS (RR = 0.87, 95% CI: 0.79-0.96). However, the association of coffee and individual components of MetS was not consistent across the studies. Pooled analysis of six studies exploring the association between tea consumption and MetS resulted in decreased odds of MetS for individuals consuming more tea (RR = 0.83, 95% CI: 0.73-0.95).

    CONCLUSIONS: Studies on coffee and NAFLD suggest that coffee consumption could have a protective role on fibrosis. Both coffee and tea consumption are associated with less likelihood of having MetS but further research with better designed studies is needed.

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  22. JP Says:

    Updated 08/21/16:


    Ann Hepatol. 2016 May-Jun;15(3):350-5.

    Nonalcoholic steatohepatitis in morbid obese patients: coffee consumption vs. disease severity.

    INTRODUCTION: Obesity correlates with nonalcoholic fatty liver disease (NAFLD) and occurs in 90 to 100% of severely obese individuals (body mass index [BMI] > 35 kg/m2). Coffee consumption (CC) has been associated with reduced progression of fibrosis in both hepatitis C infection and NAFLD; however, this topic is still under discussion when this liver disease affects severely obese individuals.

    OBJECTIVE: To assess the association between CC, insulin resistance (IR) and histological NAFLD morbid obese patients.

    MATERIAL AND METHODS: Cross-sectional study, including obese individuals undergoing bariatric surgery, liver biopsy and histological diagnosis between September 2013 and August 2014. The patients were classified into 3 groups according to their weekly CC: 0- 239.9 mL; 240-2099.9 mL and ≥ 2100 mL.

    RESULTS: A total of 112 obese individuals were included (BMI = 41.9 ± 4.3 kg/m2), with a mean age of 34.7 ± 7.4 years; 68.6% were women. CC was reported by 72.3% of patients. There were no statistical significant differences between groups regarding the presence of IR (84.8% vs. 74.2% vs. 75.9%; p = 0.536). Progressively higher percentages of individuals with normal liver histology were observed (14.7% vs. 21.9% vs. 24.3%). NASH (65.7% vs. 70.3% vs. 57.5%) were observed among those who consumed greater coffee volumes (p = 0.812). In conclusion, obese individuals with elevated CC exhibited lower frequencies of NASH, although with no statistical significance in this sample.

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  23. JP Says:

    Updated 10/06/16:


    Asia Pac J Clin Nutr. 2016 Dec;25(4):767-775.

    Coffee consumption is associated with lower serum aminotransferases in the general Korean population and in those at high risk for hepatic disease.

    BACKGROUND AND OBJECTIVES: The favourable effects of coffee on liver enzymes have been reported worldwide. This study investigated the association between coffee consumption and serum aminotransferase concentration in Korean adults.

    METHODS AND STUDY DESIGN: Data were obtained from the fourth and fifth Korea National Health and Nutrition Examination Surveys. Elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) concentration were defined as >30 IU/L for men and >19 IU/L for women. The risk of elevated ALT and AST according to general characteristics and frequency of coffee consumption were tested by chi-square tests and multiple logistic regression analyses.

    RESULTS: The prevalence of elevated ALT was 27.4%, 27.8%, and 26.9% in subjects who drank =2 times/day, respectively. The proportions of individuals with elevated AST were 32.5%, 33.1%, and 26.7% in subjects who drank =2 times/day, respectively. The aORs for elevated ALT and AST were significantly lower in subjects who drank >=2 times of coffee/day than in those who drank =2 times/day was associated with lower ORs for elevated ALT in the high-risk group overall and in the viral hepatitis and obesity subgroups, respectively. In sensitivity analysis, reduced frequency of coffee consumption was associated with an increased risk for elevated liver enzymes, although an association between coffee consumption and elevated ALT was not observed in women or current smokers.

    CONCLUSIONS: Higher coffee consumption was associated with lower risk of elevated aminotransferase concentration in Korean adults.

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  24. JP Says:

    Updated 11/11/16:


    Eur J Gastroenterol Hepatol. 2016 Nov 7.

    Coffee consumption and risk of nonalcoholic fatty liver disease: a systematic review and meta-analysis.

    BACKGROUND/OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) is a worldwide public health concern. Coffee might have a protective effect against NAFLD. However, the results of previous reports are conflicting. Therefore, we carried out this meta-analysis to summarize all available data.

    METHODS: This study consisted of two meta-analyses. The first meta-analysis included observational studies comparing the risk of NAFLD in patients who did and did not drink coffee. The second analysis included studies comparing the risk of liver fibrosis between NAFLD patients who did and did not drink coffee. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated.

    RESULTS: Out of 355 articles, five studies fulfilled our eligibility criteria and were included in the analysis. The risk of NAFLD in patients who drank coffee was significantly lower than that in patients who did not pooled RR 0.71 (95% CI, 0.60-0.85). We also found a significantly decreased risk of liver fibrosis among NAFLD patients who drank coffee compared with those who did not, with a pooled RR of 0.70 (95% CI, 0.60-0.82). However, it should be noted that the definition of regular coffee consumption varied between studies, which is the main limitation of this meta-analysis.

    CONCLUSION: Our study found a significantly decreased risk of NAFLD among coffee drinkers and significantly decreased risk of liver fibrosis among patients with NAFLD who drank coffee on a regular basis. Whether consumption of coffee could be considered a preventative measure against NAFLD needs further investigations.

    Be well!


  25. JP Says:

    Updated 01/13/17:


    Nutrients 2017, 9(1), 56

    Coffee Intake Is Associated with a Lower Liver Stiffness in Patients with Non-Alcoholic Fatty Liver Disease, Hepatitis C, and Hepatitis B

    Abstract: There is emerging evidence for the positive effects or benefits of coffee in patients with liver disease. We conducted a retrospective cross-sectional study on patients with non-alcoholic fatty liver disease (NAFLD), hepatitis C virus (HCV), and hepatitis B virus (HBV) infection to determine the effects of coffee intake on a non-invasive marker of liver fibrosis: liver stiffness assessed by transient elastography (TE). We assessed coffee and tea intake and measured TE in 1018 patients with NAFLD, HCV, and HBV (155 with NAFLD, 378 with HCV and 485 with HBV). Univariate and multivariate regression models were performed taking into account potential confounders. Liver stiffness was higher in males compared to females (p < 0.05). Patients with HBV had lower liver stiffness than those with HCV and NAFLD. After adjustment for age, gender, smoking, alcohol consumption, M or XL probe, and disease state (NAFLD, HCV, and HBV status), those who drank 2 or more cups of coffee per day had a lower liver stiffness (p = 0.044). Tea consumption had no effect (p = 0.9). Coffee consumption decreases liver stiffness, which may indicate less fibrosis and inflammation, independent of disease state. This study adds further evidence to the notion of coffee maybe beneficial in patients with liver disease. Be well! JP

  26. JP Says:

    Updated 11/29/18:

    Nutr Cancer. 2018 Nov 20:1-7.


    Coffee, Green Tea, and Caffeine Intake and Liver Cancer Risk: A Prospective Cohort Study.

    We aimed to investigate whether coffee, green tea, and caffeine intake are associated with liver cancer risk, using data of a prospective cohort study. This study included 30,824 participants (14,240 men and 16,584 women) aged 35 years or older in the Takayama study, which was launched on September 1, 1992. The consumption frequencies of coffee and green tea were assessed using a self-administered questionnaire. Caffeine intake was estimated from the consumption frequencies of caffeine-containing beverages and foods and their caffeine content per serving. The incidence of liver cancer was confirmed using regional population-based cancer registries. During the follow-up period of 16 years, a total of 172 participants developed liver cancer. The adjusted hazard ratios and 95% confidence intervals (CIs) in relation to coffee consumption were 0.65 (95% CI: 0.46-0.93) for less than once per day, 0.63 (95% CI: 0.39-1.02) for once per day, and 0.40 (95% CI: 0.20-0.79) for twice per day or more, compared with nondrinkers. No associations with green tea, black tea and caffeine intake were observed. The present study confirmed that coffee consumption significantly reduces liver cancer risk and raises the possibility that caffeine intake might not account for the association.

    Be well!


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