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Coffee Slows Progression of Liver Disease in Hepatitis C Patients with Advanced Fibrosis or Cirrhosis

Among chronic hepatitis C patients with advanced liver fibrosis or cirrhosis who did not respond to interferon-based therapy, those who drank 3 or more cups of coffee per day had a 53% lower risk of liver disease progression than non-coffee-drinkers, according to a study that will appear in the November 2009 issue of Hepatology. A similar effect was not observed among patients who drank black or green tea.

Neal Freedman from the National Cancer Institute and colleagues examined the relationship between coffee consumption and liver disease progression in individuals with chronic hepatitis C virus (HCV) infection who did not respond to standard treatment. In prior research, higher coffee consumption has been inversely associated with incidence of chronic liver disease in population studies, the authors noted as background.

This study included 766 participants enrolled in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) trial who had HCV-related bridging fibrosis or cirrhosis and failed to respond to antiviral therapy using pegylated interferon plus ribavirin. Primary results from the trial showed that long-term pegylated interferon maintenance therapy did not reduce the risk of liver disease progression.

At the start of the study, HALT-C participants were asked to report their typical frequency and amount of coffee consumption over the past year, using 9 frequency categories (ranging from "never" to "every day") and 4 portion size categories (1 cup, 2 cups, 3-4 cups, and 5+ cups). A similar question was asked about black and green tea consumption.

Participants were seen every 3 months during the 3.8-year study period to assess clinical outcomes including ascites (abnormal accumulation of fluid in the abdomen), hepatic encephalopathy (brain damage), spontaneous bacterial peritonitis, variceal hemorrhage (bleeding varicose veins), hepatocellular carcinoma (liver cancer), increased fibrosis, and death related to liver disease. Liver biopsies were taken at 1.5 and 3.5 years to determine liver disease progression.

At baseline, people who drank more coffee had significantly less severe steatosis (fat accumulation in the liver), lower serum AST-to-ALT ratio, lower alpha-fetoprotein (a marker for liver cancer), lower insulin and HOMA2 score, and higher albumin levels compared with non-coffee-drinkers.

Over the follow-up period, results showed that participants who drank 3 or more cups of coffee per day had a relative risk of 0.47 -- or 53% less -- for reaching one of the predefined clinical outcomes.

Outcome rates declined with increasing coffee consumption, from 11.1 per 100 person-years [PY] for patients who drank none, to 12.1 per 100 PY for those who drank less than 1 cup a day, to 8.2 per 100 PY for those who drank between 1 to fewer than 3 cups a day, to 6.3 per 100 PY for patients who drank 3 or more cups a day.

The researchers did not observe any association between black or green tea intake and liver disease progression, though reported tea consumption was low during the study period.

"Given the large number of people affected by HCV, it is important to identify modifiable risk factors associated with the progression of liver disease," said Dr. Freedman. "Although we cannot rule out a possible role for other factors that go along with drinking coffee, results from our study suggest that patients with high coffee intake had a lower risk of disease progression."

Results from this study should not be generalized to healthier people without liver disease, the researchers cautioned.

National Cancer Institute, National Institutes of Health (NIH), Rockville, MD; National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD; Keck School of Medicine, University of Southern California, Los Angeles, CA; New England Research Institutes, Watertown, MA; Virginia Commonwealth University Medical Center, Richmond, VA; University of Texas Southwestern Medical Center, Dallas, TX; University of Michigan Medical Center, Ann Arbor, MI; Saint Louis University School of Medicine, St. Louis, MO; University of Connecticut Health Center, Farmington, CT; University of California at Irvine, Irvine, CA; Massachusetts General Hospital and the Department of Medicine, Harvard Medical School, Boston, MA; University of Washington, Seattle, WA.

10/23/09

Reference
ND Freedman, JE Everhart, KL Lindsay, and the HALT-C Trial Group. Coffee Intake Is Associated with Lower Rates of Liver Disease Progression in Chronic Hepatitis C. Hepatology. Published online July 13, 2009. (Abstract).