Coffee consumption and risk chronic diseases: the epidemiological evidence

1
Coffee consumption and risk chronic
diseasesthe epidemiological evidence
Rob M. van Dam, PhD
Department of Nutrition Harvard School of Public
Health

• Channing Laboratory
• Brigham and Womens Hospital,
• and Harvard Medical School

2
Contribution of coffee to dietary intake

• Chlorogenic acid and quinides (primary source)
• Other antioxidants
• Caffeine (primary source)
• Lignans
• Magnesium
• Potassium
• Manganese
• Trigonelline and niacin
• Chromium
• Fiber
• Diterpenes Kahweol and Cafestol

3
Kahweol and cafestol in different types of coffee
(Urgert R et al. J Agric Food Chem
1995432167-72)
4
Changes in serum total cholesterol,
LDL-cholesterol, triglycerides, and
HDL-cholesterol in 22 subjects drinking 0.9 L
cafetiere coffee daily for 24 weeks (Urgert R, et
al. BMJ 1996)
5
Effect of caffeine and caffeinated coffee intake
on blood pressure summary estimates for trials
of at least 7 days
Noordzij M, et al. J Hypertension 2006
6
Effects of coffee different than expected from
its caffeine content

• Exercise performance time and epinephrine
  response (Graham TE, J Appl Physiol 1998)
• Postload glucose concentrations and lypolysis
• (Battram DS, J Nutr 2006)
• Blood pressure
• (Noordzij M, J Hypertens 2005 Winkelmayer WC,
  JAMA 2005)

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Effects of Caffeine on Endurance Times
100
Spriet et al, 1992
Costill et al, 1978
Trice Haymes, 1995
Cohen et al, 1996
80
Van Soeren et al. 1998
Cadarette et al, 1982
Graham Spriet, 1991
Graham Spriet, 1995
Butts Crowell, 1985
Pasman et al, 1995
60
Sasaki et al, 1987
Caffeine/Coffee (min)
Graham et al, 1998
Greer et al, 2000
40
Bell McLellan, 2002
Plb vs Caf
Mohr et al, 1998
20
Flinn et al, 1990
Decaf vs Coffee
Plb vs Caf/Ele
Collomp et al, 1990
Perkins Williams, 1975
Jackman et al, 1996
0
0
20
40
60
80
100
Placebo/Decaf (min)
8
Graham et al. JAP 85 883-889, 1998

Coffee is not just caffeine
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Caffeine and older individuals
Norager,et. al., J Appl Physiol. 99 2302-2306,
2005

• 15 women, 15 men 74.7 years healthy
• daily coffee 4.9 cups/day
• 2 day withdraw 6 mg/kg
• cycling endurance at 65 HR max
• endurance at 50 max strength
• postural stability

10
Physical Performance and Perceived
EffortEndurance
25 improvement
(min)
Norager,et. al., J Appl Physiol. 99 2302-2306,
2005
11
Physical Performance and Perceived
EffortIsometric Sub-Maximal Strength
54 improvement
(s)
Norager,et. al., J Appl Physiol. 99 2302-2306,
2005
12
Postural SwayVelocity Moment
Eyes open (25), closed (40) worse
(mm2/s)
Norager,et. al., J Appl Physiol. 99 2302-2306,
2005
13
Prospective cohort studies of coffee and risk of
coronary heart disease (CHD)

• Nurses Health Study
• N84,488 women
• 20 years of follow-up
• 2254 incident cases of CHD
• Health Professionals Follow-up Study
• N44,005 men
• 14 years of follow-up
• 2173 incident cases of CHD

Lopez-Garcia E, et al. Circulation 2006
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Caffeinated coffee and CHD risk
Adjusted for age, smoking, body mass index,
physical activity, alcohol intake, parental
history of myocardial infarction, use of aspirin,
use of vitamin supplements, hypertension,
hypercholesterolemia, diabetes mellitus at
baseline, menopausal status, hormone therapy
15
Case-control study of coffee, CYP1A2 genotype and
myocardial infarction (Cornelis MC et al 2006)
16
Coffee and cancer risk
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High coffee consumption during pregnancy

• Associations with lower birth weight reported,
  but not in a randomized trial of moderate amounts
  of caffeinated vs. decaffeinated coffee
• (Fernandes O et al 1998, Clausson B et al 2002)
• Few studies reported association with risk of
  childhood leukemia, but not consistent
• (Menegaux F et al 2005, Petridou E 1997)
• Higher sensitivity of the fetus to caffeine

18
Robinson, Spafford, Graham, and
Smith(unpublished)
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Studies of habitual coffee consumption and risk
of type 2 diabetes
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Effect of Caffeine on Insulin Sensitivity in
Obesity and Type 2 Diabetes
Caffeine significantly lower than placebo in all
trials (P 20
Greater than pre-treatment (P

15
Glucose Uptake (mg/kgSM.min-1)
10
Placebo
5
0
Pre
Pre
Post
Pre
Post
Post
Lean
Obese
T2D
Glucose uptake was measured 4 days post exercise
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Insulin Sensitivity Index for Various Studies
During Placebo and Caffeine Trials
8
6
CAFFEINE
4
2
0
0
2
4
6
8
10
12
PLACEBO
Index calculation reference Matsuda De
Fronzo. Diabetes Care 221462, 1999.
22
Is caffeine the same as coffee ?
Venous Blood Samples
fasting blood sample
Glucose Lactate Insulin C-peptide
FFA Glycerol Incretins (GLP-1 GIP)
-15 0 15 30 45 60 90 120 150 180
185 200 215 230 245 275 305
t(min)
tchallenge2 0 15 30 45 60 90 120
Catecholamines Methylxanthines
CHO Challenge 1
CHO Challenge 2 (given AFTER blood sample _at_
180min)
Coffee (5mg/kg caffeine), Decaf, Water 75g CHO
(Crispix skim milk) 15 min to eat Blood
sample 2 taken immediately after meal
completion
75g OGTT (Trutol) 5 min to ingest
L. Moisey (in progress)
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Results First Meal
24
First Meal Glucose
25
Second Meal Insulin
26
Second Meal Glucose
27
Coffee consumption and incidence of type 2
diabetesin the Netherlands
?
?
Van Dam RM, Feskens EJ. Lancet 2002.
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Characteristics by coffee consumption
?
?
29
Coffee consumption and risk of type 2 diabetes
in Dutch adults
van Dam RM, Feskens EJM. Lancet 2002
30
Coffee and risk of type 2 diabetes (van Dam Hu
JAMA 2006)
Highest (? 6-7 cups/d) vs. lowest (? 0-2 cups/d)
coffee consumption

relative risk
Study
95 CI
van Dam
Reunanen
Rosengren
Salazar-Martinez, M
Salazar-Martinez, F
Tuomilehto
Carlsson
Hoorn
Total (95 CI)
0.65 (0.54-0.78)
0.1
0.2
0.5
1
2
5
10
Favours high coffee
Favours low coffee
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Coffee and risk of type 2 diabetes
2nd highest (4-6 cup/d) vs. lowest (? 0-2 cups/d)
coffee consumption

relative risk
Study
95 CI
van Dam
Reunanen
Rosengren
Salazar-Martinez, M
Salazar-Martinez
Tuomilehto
Carlsson
Hoorn
Total (95 CI)
0.72 (0.62-0.83)
0.1
0.2
0.5
1
2
5
10
Favours coffee
Favours no coffee
32
Cohort studies of coffee and risk of type 2
diabetes published after the 2006 meta-analysis
33
Long term coffee consumption and diabetes risk
34
Size of coffee cups
35
Coffee and adjusted 2-hr glucose the Hoorn
Study(van Dam et al. Diabetologia 2004)
P trend0.001
P trend 36
Change in caffeinated coffee consumption and
change in weight over 12 years
Lopez-Garcia E, et al. Am J Clin Nutr
200683674-80
37
Change in caffeinated coffee consumption and
change in weight over 12 years
Very small difference in weight for a 12 year
period
Lopez-Garcia E, et al. Am J Clin Nutr
200683674-80
38
Coffee, caffeine, and risk of type 2 diabetes in
U.S. women
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Conclusions

• Although coffee was associated with CVD and
  cancer risk in earlier studies, this has not been
  confirmed in larger prospective studies
• Coffee consumption is associated with a lower
  risk of liver cancer and type 2 diabetes. Coffee
  components other than caffeine appear to
  contribute to the inverse association with type 2
  diabetes.
• There is some concern about health effects of
  high intakes of caffeine during pregnancy on the
  fetus
• For most adults, coffee does not appear to
  increase risk of major chronic diseases and
  quitting smoking, engaging in physical activity,
  and a healthy diet should be prioritized for the
  prevention of chronic diseases

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Acknowledgments

• Harvard
• Frank Hu, JoAnn Manson, Walter Willett,
• Esther Lopez-Garcia
• Netherlands
• Edith Feskens, Rob Heine, Coen Stehouwer,
• Lex Bouter, Giel Nijpels, Jacqueline Dekker