and Liver Disease in People with
Regularly consuming larger amounts of caffeine has a significant
beneficial effect on liver inflammation, but not fibrosis,
according to biopsy results from people with chronic hepatitis
medical literature includes an increasing number of studies suggesting
that the consumption of caffeine may reduce liver injury in people
with chronic liver disease. Several studies have shown that caffeine
consumption is associated with improvements in a number of factors
in people at risk for progressive liver disease: alanine aminotransferase
(ALT) levels, fibrosis,
cirrhosis, and other
clinical outcomes including hepatocellular
carcinoma and death.
in the June
2011 Journal of Hepatology, Charlotte Costentin and colleagues
in France set out to evaluate the association between caffeine intake
and histological liver injury revealed by biopsies in people with
untreated chronic hepatitis C virus
researchers enrolled 238 patients with chronic hepatitis C at
Groupe Hospitalier Henri Mondor-Albert Chenevier between 2004
and 2006. All participants were treatment-naive and had previously
received or agreed to a liver biopsy. Exclusion criteria included
coinfection with hepatitis B virus or HIV.
ranged in age from 34 to 56 years; 65% were men and 35% were women.
Injection drug use was the main route of HCV infection. HCV genotype
1 accounted for 62% of infections, followed by genotype 3 at 17%.
completed a questionnaire about their use of caffeine (coffee,
caffeinated tea, and caffeinated soda), alcohol, tobacco, and
cannabis during the previous 6 months. Participants were asked
about the quantity and frequency of their daily caffeine consumption
over the previous 6 months. Serum ALT levels and fasting blood
glucose were measured at the same time the liver biopsy was performed
and the questionnaire administered.
the participants' biopsy results, the researchers used the Metavir
scoring system to determine the degree of fibrosis and histological
activity or liver inflammation. The Metavir system assigns 2 standardized
numbers: one describes the degree of fibrosis, while the other measures
the degree of inflammation. Fibrosis is scored on a scale from F0
to F4 and histological activity is scored on a scale from A0 to
= absent fibrosis
= mild fibrosis
= moderate fibrosis
= advanced fibrosis
= no inflammation
= mild inflammation
= moderate inflammation
= severe inflammation
were classified into 4 groups reflecting their daily caffeine consumption:
1 = < 225 mg/day (less than 1.5 cup/day)
2 = 225-407 mg/day (more than 1.5 but less than 3 cups/day)
3 = 408-678 mg/day (at least 3 but less than 5 cups/day)
4 = > 678 mg/day (at least 5 cups/day)
study compared participants' caffeine consumption and its correlation
with histological activity, degree of fibrosis, and serum ALT levels.
activity scores > A2 declined gradually with increasing amounts
of caffeine consumed:
participants in Group 1 (less than 1.5 cups/day), 78%
had a Metavir activity score of A2 or greater.
the participants in Group 4 (at least 5 cups/day), 48%
had an inflammation score of A2 or greater.
number of participants with a Metavir activity score of
A3 was 10, too small to draw conclusions, and scores of
A4, if any, were not reported.
factors related to a score > A2 included age > 40 years,
BMI > 25, moderate or marked steatosis (fatty liver), fibrosis
>F2, and elevated ALT levels.
significant relationships were observed between inflammation
score and sex, route of HCV transmission, hyperglycemia, diabetes,
alcohol use, tobacco use, cannabis use, or HCV genotype.
Metavir activity score > A2 was related to fibrosis stage
F2-F4, moderate to severe steatosis, and elevated ALT levels.
>F2 was significantly correlated with male sex, age
> 40 years, alcohol abuse, tobacco use (more than 15 cigarettes/day),
daily cannabis use, HCV genotype 3, BMI > 25, moderate to
severe steatosis, and elevated ALT levels.
was no association, however, between fibrosis severity and caffeine
there was no association between caffeine consumption and ALT
use was not independently associated with Metavir activity levels;
however, the proportion of heavy smokers rose with increasing
researchers noted 2 possible limitations of their study. "Socio-economic
status, quality of life, and comorbidities, which may be significantly
associated with coffee intake, have not been examined in our cohort,"
they wrote. The absence of this information limits the scope of
the study since other factors associated with caffeine consumption
could explain the study results. Additionally, there was a low prevalence
of alcohol use among study participants, which may account for the
weak impact of alcohol consumption on necroinflammation.
study uncovers an inverse relationship between caffeine consumption
and Metavir activity grade in patients with chronic hepatitis C,
suggesting that caffeine intake may lower necroinflammatory injury
by an as yet undetermined mechanism," the authors wrote.
the strong relationship between activity grade and fibrosis progression,
these results support the hypothesis that caffeine intake may also
reduce the progression of liver fibrosis," they concluded.
"Additional studies are required to assess whether our findings
also apply to other inflammatory chronic liver diseases."
that hepatitis C is influenced by many co-factors and co-morbidities
that affect disease progression and long-term outcomes, the researchers
did not make any clinical recommendation regarding caffeine consumption
and liver disease. However, this study adds to the increasing evidence
that caffeine consumption does not appear to be harmful to people
with liver disease and may, in fact, be beneficial.
Service d'Hépatologie et de Gastroentérologie, Groupe
Hospitalier Henri Mondor-Albert Chenevier, Créteil 94000,
France; INSERM, U955, Créteil 94000, France; Université
Paris-Est, Faculté de Médecine, UMR-S955, Créteil
94000, France; Service de Santé publique, Groupe Hospitalier
Henri Mondor-Albert Chenevier, Créteil 94000, France; Service
d'Anatomo-pathologie, Groupe Hospitalier Henri Mondor-Albert Chenevier,
Créteil 94000, France; Service de Virologie, Groupe Hospitalier
Henri Mondor-Albert Chenevier, Créteil 94000, France.
Costentin, F Roudot-Thorava, ES Zafrani, et al. Association of caffeine
intake and histological features of chronic hepatitis C. Journal
of Hepatology 54(6): 1123-1129 (abstract).