Coffee and Mortality

N Engl J Med 2012;366:1891-904.

2012.9.18R4Younghee Jung/Staff Kiwon Kim

Introduction

• Coffee – Contains caffeine, a stimulant and a rich source of antioxidants

and other bioactive compounds – Coffee drinking is not generally considered to be part of a healthy

lifestyle

Introduction

• Association between coffee consumption and other major causes of death – Inverse associations with diabetes, inflammatory diseases, stroke, and in-

juries and accidents, although associations with cancer have generally been null.

– The results of studies of coffee consumption and total mortality have been mixed.

• Data are lacking – To clarify the association between coffee drinking and mortality.– To determine whether there is a dose–response relationship.– To assess whether associations are consistent across various subgroups.

Introduction

• National Institutes of Health (NIH)–AARP Diet and Health Study • To determine whether coffee consumption is associated with total or cause-specific

mortality

*AARP: formally the American Association of Retired Persons

Methods

• Study Population– Between 1995 and 1996, a total of 617,119 AARP members, 50 to 71

years of age, returned a comprehensive questionnaire assessing diet and lifestyle

– Exclusion criteria: By a spouse or other surrogate correspondent Cancer, heart disease, previous strokeWithout information on coffee use, or cigarette smokingExtremely low or high caloric consumptionDied before their completed questionnaire was received.

– The resulting analytic cohort included 229,119 men and 173,141 women.

Methods

• Assessment of Exposure– Coffee consumption

• 0~6 or more cups per day• 96.5% of coffee drinkers provided information on whether they

drank caffeinated or decaffeinated coffee more than half the time.

Methods

• Cohort follow-up– Baseline (1995-1996) until the date of death or Dec 31, 2008– Specific causes of death was obtained through ICD-9 and ICD-10

• Statistical analysis– Cox proportional-hazards regression models – Hazard ratios and 95% CI for mortality associated with coffee– Multivariate models: adjust possible variables

• age, BMI, race, level of education, alcohol consumption, cigarette smoking, health status, DM, marital status, level of physical activity, total energy intake, consumption of fruits, vegetables, red meat , white meat, saturated fat…

Results

• During 14 years of follow-up – Median, 13.6 years; total person-years, 5,148,760 – 33,731 men and 18,784 women died

Coffee drinkers were more likely to smoke cigarettes and consume more than three alcoholic drinks/d, more red meat, lower level of education, less likely to engage in vigorous physical activ-ity, reported lower levels of consumption of fruits, vegetables, and white meat, less likely to report having diabetes

Results

• In age-adjusted analyses – Coffee consumption was associated with increased mortality among both men

and women

• However, after multivariate adjustment for potential confounders, particu-larly smoking – A modest inverse association between coffee drinking and total mortality was ob-

served for both sexes

Conclusion

• Large, prospective U.S. cohort study– A dose-dependent inverse association between coffee drinking

and total mortality, after adjusting for potential confounders (smok-ing status in particular)

– As compared with men who did not drink coffee, men who drank 6 or more cups of coffee/d had a 10% lower risk of death, whereas women in this category of consumption had a 15% lower risk.

– Similar associations were observed whether participants drank predominantly caffeinated or decaffeinated coffee

Conclusion

• Limitations– Associations could reflect confounding by unmeasured

or poorly measured confounders– Reverse causality

• Since persons with chronic disease and poor health might abstain from coffee drinking• But, excluded persons who had cancer or cardiovascular dis-

ease at baseline

Conclusion

• Limitations– Coffee consumption assessment by self-report at a single time

point and may not reflect long-term patterns of consumption– The subject distinction between caffeinated and decaffeinated cof-

fee – Lacked data on how coffee was prepared.

• Provide reassurance with respect to the concern that coffee drinking might adversely affect health.

Health Effects of Coffee

Comment

최승자 詩 ‘그거’

술은 끊어도 담배는 못 끊겠는 거 , 그거 .

담배는 끊어도 커피는 못 끊겠는 거 , 그거 .

커피는 끊어도 목숨은 못 끊겠는 거 , 그거 .

믿지 못하는 사이 두 발이 푹푹 빠져 들어 간다 .

빠져 들어간다는 것까지도 믿지 못하는 사이로

두 발은 더욱 습한 곳으로 푹푹 빠져 들어 간다 .

( 나의 이성과 감정은 언제나 나의 현실보다 뒤지는 거 , 그거 .)

tolerance to the caffeine-induced pressor effect develops in habitual coffee drinkers

ingredients other than caffeine may also have BP-control effects, including chlorogenic acid, flavonoids, melanoidins, quinide, magnesium, cafestol, and kahweol

also rich in potassium, which lowers BP

This may help to explain the observed inverse “J-shape” relation between habitual coffee drinking and hyperten-sion risk

Instant Coffee

caffeine content of instant coffee is generally less than that of brewed coffee

the polyphenol content of a 180 ml cup of instant coffee has been estimated to be approximately 320 mg, com-pared to approximately 400 mg in a cup of brewed coffee of the same size

as efficient in decreasing the risk of diabetes type 2 decreases intestinal iron absorption more than drip coffeeAnimal experiments have indicated that instant coffee con-

fers no risk related to reproduction, lactation, embryotoxic-ity or teratogenicity, but possibly a risk of a delay in bone calcification in high doses