AASLD: More Evidence Coffee May Slow Liver Disease

From Reuters Health Information

By Anne Harding

NEW YORK (Reuters Health) Nov 03 - Drinking coffee could help slow the progression of fibrosis in patients with fatty liver disease, according to new research presented at the American Association for the Study of Liver Diseases' annual meeting in Boston.

And a separate study presented at the same meeting found that patients with chronic hepatitis C who drank the most coffee and had failed standard treatment fared much better with retreatment.

Since the early 1990s, several studies have suggested benefits of coffee drinking for liver health, Dr. Jeffrey W. Molloy and Dr. Stephen A. Harrison and their colleagues at Brooke Army Medical Center in San Antonio, Texas, note in their report. In 2009, Dr. Harrison noted in an interview, two studies showed drinking about 2.5 cups of coffee daily reduced the risk of hepatic steatosis in patients with hepatitis C.

For the current study, the Texas researchers used a group of asymptomatic individuals whom they had initially screened for liver disease with ultrasound, giving them a "nice clean cohort of patients" with no liver disease who served as controls, Dr. Harrison told Reuters Health. Patients with ultrasound tests suggesting fatty liver disease underwent percutaneous liver biopsies.

Their analysis included 177 controls, 89 patients with simple steatosis, 31 patients with nonalcoholic steatohepatitis (NASH) and stage 0-1 fibrosis, and nine patients with NASH and stage 2-4 fibrosis.

Among the NASH patients, the researchers found, those with less severe disease drank significantly more coffee than those with more severe fibrosis. The patients with NASH stage 0-1 fibrosis consumed an average of 413 mg of caffeine and 312 mg of coffee, compared to 189 mg of caffeine (p=0.035) and 79 mg of coffee (p=0.03) for the NASH stage 2-4 fibrosis patients.

The 75th quartile for daily coffee consumption was 343 mg, or about 2.5 cups, the researchers found. Ten percent of patients who consumed this much coffee had NASH stage 2-4 disease, compared to roughly half of the patients who didn't drink coffee at all. Logistic regression analysis showed that the risk of severe fibrosis declined as caffeine and coffee consumption rose (p=0.023 for both).

"There's definitely a relationship, we don't know exactly what it is yet," between coffee and fibrosis, Dr. Harrison said. He called the findings "provocative" and "hypothesis-generating," noting that a prospective interventional study would be needed to determine a causal relationship.

Nevertheless, he and his colleagues conclude, "moderate caffeine and/or coffee consumption may be a benign adjunct to the comprehensive management of NASH patients."

In the second study, Dr. Neal D. Freeman of the National Cancer Institute and his colleagues found that among 885 patients with chronic hepatitis C who failed standard treatment with interferon, those who drank more coffee responded better to retreatment with peg interferon alfa 2a and ribavirin.

The median log10 drop from baseline to week 12 of retreatment was 1.7 among non-coffee drinkers, compared to 3.7 for those who drank three cups or more daily (p for trend across categories < 0.0001).

There also were "highly statistically significant trends" in early virologic response (EVR, defined as a two log10 drop in HCV RNA at week 12), undetectable HCV RNA at week 20 of treatment, and sustained virologic response (SVR, at week 72, 24 weeks after the end of treatment).

For example, 11.3% of non-coffee drinking patients had an SVR, compared to 25.8% of patients who drank at least three cups a day. The EVR rate was 45.7% in non-coffee drinkers and 72.7% in the heaviest coffee drinkers. And among the non-coffee drinkers, 26.3% had undetectable levels of HCV RNA at week 20 of the study, compared to 52.3% of people who drank three or more cups daily (p for trend in all three categories <0.0001).

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