Advertisement

Coffee and herbal tea consumption is associated with lower liver stiffness in the general population: The Rotterdam study

      Background & Aims

      Coffee and tea have been proposed to limit the progression of liver fibrosis in established liver disease, but it is unknown if this is also true for subclinical fibrosis. We therefore aimed to evaluate whether coffee and tea consumption are associated with liver stiffness in the general population.

      Methods

      The Rotterdam Study is an ongoing prospective population-based cohort. We included participants who underwent transient elastography, ultrasound and completed a food frequency questionnaire. Coffee and tea consumption were categorized into no, moderate (>0–3), or frequent (⩾3) intake (cups/day), and tea further into green, black and herbal tea (no/any). Significant fibrosis was defined as liver stiffness measurements (LSM) ⩾8.0 kPa. We performed regression analyses relating coffee and tea intake with fibrosis, steatosis and log-transformed LSM and adjusted for energy, sugar and creamer intake, age, gender, BMI, steatosis/LSM, HOMA-IR, ALT, alcohol, smoking, soda, healthy diet index and physical activity.

      Results

      We included 2,424 participants (age 66.5 ± 7.4; 43% male) of whom 5.2% had LSM ⩾8.0 kPa and 34.6% steatosis. Proportion of LSM ⩾8.0 kPa decreased with higher coffee consumption (7.8%, 6.9% and 4.1% for no, moderate and frequent respectively; Ptrend = 0.006). This inverse association was confirmed in multivariable regression (ORmod 0.75, 95% CI 0.33–1.67; ORfreq 0.39, 95% CI 0.18–0.86; p = 0.005). Amongst tea consumers, only herbal tea consumers (36.3%) had lower log-transformed LSM after adjustment (Beta-0.05, 95% CI-0.08;-0.02, p = 0.001). Subtypes of tea were associated with steatosis in univariate but not multivariable analysis.

      Conclusions

      In the general population, frequent coffee and herbal tea consumption were inversely related with liver stiffness but not steatosis. Longitudinal analyses, as well as studies validating and unravelling underlying mechanisms are needed.

      Lay summary

      The Rotterdam Study is a large ongoing population study of suburban inhabitants of Rotterdam in whom data on liver stiffness, as proxy for liver fibrosis, presence of fatty liver on ultrasound and detailed information on coffee and tea consumption were obtained in 2,424 participants. The consumption of herbal tea and daily consumption of three or more cups of coffee was related to the presence of lower liver stiffness, independent of a great number of other lifestyle and environmental factors. Previous studies have found a protective effect of coffee on established liver disease and we now show for the first time that this effect is already measurable in the general population.

      Graphical abstract

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hepatology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      Author names in bold designate shared co-first authorship

        • Lozano R.
        • Naghavi M.
        • Foreman K.
        • Lim S.
        • Shibuya K.
        • Aboyans V.
        • et al.
        Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.
        Lancet. 2012; 380: 2095-2128
        • Murray C.J.
        • Vos T.
        • Lozano R.
        • Naghavi M.
        • Flaxman A.D.
        • Michaud C.
        • et al.
        Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.
        Lancet. 2012; 380: 2197-2223
        • Koehler E.M.
        • Plompen E.P.
        • Schouten J.N.
        • Hansen B.E.
        • Darwish Murad S.
        • Taimr P.
        • et al.
        Presence of diabetes mellitus and steatosis is associated with liver stiffness in a general population: The Rotterdam study.
        Hepatology. 2016; 63: 138-147
        • Roulot D.
        • Costes J.L.
        • Buyck J.F.
        • Warzocha U.
        • Gambier N.
        • Czernichow S.
        • et al.
        Transient elastography as a screening tool for liver fibrosis and cirrhosis in a community-based population aged over 45 years.
        Gut. 2011; 60: 977-984
        • Wong V.W.
        • Chu W.C.
        • Wong G.L.
        • Chan R.S.
        • Chim A.M.
        • Ong A.
        • et al.
        Prevalence of non-alcoholic fatty liver disease and advanced fibrosis in Hong Kong Chinese: a population study using proton-magnetic resonance spectroscopy and transient elastography.
        Gut. 2012; 61: 409-415
        • Serfaty L.
        Clinical implications of concomitant alcohol use, obesity, and viral hepatitis.
        Gastroenterology. 2016; 150: 1718-1722
        • Marventano S.
        • Salomone F.
        • Godos J.
        • Pluchinotta F.
        • Del Rio D.
        • Mistretta A.
        • et al.
        Coffee and tea consumption in relation with non-alcoholic fatty liver and metabolic syndrome: A systematic review and meta-analysis of observational studies.
        Clin Nutr. 2016; 35: 1269-1281
        • Yesil A.
        • Yilmaz Y.
        Review article: coffee consumption, the metabolic syndrome and non-alcoholic fatty liver disease.
        Aliment Pharmacol Ther. 2013; 38: 1038-1044
        • Eskelinen M.H.
        • Ngandu T.
        • Tuomilehto J.
        • Soininen H.
        • Kivipelto M.
        Midlife coffee and tea drinking and the risk of late-life dementia: a population-based CAIDE study.
        J Alzheimers Dis. 2009; 16: 85-91
        • Khan N.
        • Mukhtar H.
        Tea and Health: Studies in Humans.
        Curr Pharm Des. 2013; 19: 6141-6147
        • Arnesen E.
        • Huseby N.-E.
        • Brenn T.
        • Try K.
        The Tromsø Heart Study: Distribution of, and determinants for, gamma-glutamyltransferase in a free-living population.
        Scand J Clin Lab Invest. 1986; 46: 63-70
        • Ruhl C.E.
        • Everhart J.E.
        Coffee and caffeine consumption reduce the risk of elevated serum alanine aminotransferase activity in the United States.
        Gastroenterology. 2005; 128: 24-32
        • Klatsky A.L.
        • Armstrong M.A.
        Alcohol, smoking, coffee, and cirrhosis.
        Am J Epidemiol. 1992; 136: 1248-1257
        • Modi A.A.
        • Feld J.J.
        • Park Y.
        • Kleiner D.E.
        • Everhart J.E.
        • Liang T.J.
        • et al.
        Increased caffeine consumption is associated with reduced hepatic fibrosis.
        Hepatology. 2010; 51: 201-209
        • Anty R.
        • Marjoux S.
        • Iannelli A.
        • Patouraux S.
        • Schneck A.-S.
        • Bonnafous S.
        • et al.
        Regular coffee but not espresso drinking is protective against fibrosis in a cohort mainly composed of morbidly obese European women with NAFLD undergoing bariatric surgery.
        J Hepatol. 2012; 57: 1090-1096
        • Bambha K.
        • Wilson L.A.
        • Unalp A.
        • Loomba R.
        • Neuschwander-Tetri B.A.
        • Brunt E.M.
        • et al.
        Coffee consumption in NAFLD patients with lower insulin resistance is associated with lower risk of severe fibrosis.
        Liver Int. 2014; 34: 1250-1258
        • Zelber-Sagi S.
        • Salomone F.
        • Webb M.
        • Lotan R.
        • Yeshua H.
        • Halpern Z.
        • et al.
        Coffee consumption and nonalcoholic fatty liver onset: a prospective study in the general population.
        Transl Res. 2015; 165: 428-436
        • Klatsky A.L.
        • Morton C.
        • Udaltsova N.
        • Friedman G.D.
        COffee, cirrhosis, and transaminase enzymes.
        Arch Intern Med. 2006; 166: 1190-1195
        • Tanaka K.
        • Tokunaga S.
        • Kono S.
        • Tokudome S.
        • Akamatsu T.
        • Moriyama T.
        • et al.
        Coffee consumption and decreased serum gamma-glutamyltransferase and aminotransferase activities among male alcohol drinkers.
        Int J Epidemiol. 1998; 27: 438-443
        • Kono S.
        • Shinchi K.
        • Imanishi K.
        • Todoroki I.
        • Hatsuse K.
        Coffee and serum gamma-glutamyltransferase: a study of self-defense officials in Japan.
        Am J Epidemiol. 1994; 139: 723-727
        • Imai K.
        • Nakachi K.
        Cross sectional study of effects of drinking green tea on cardiovascular and liver diseases.
        BMJ. 1995; 310: 693-696
        • Sakata R.
        • Nakamura T.
        • Torimura T.
        • Ueno T.
        • Sata M.
        Green tea with high-density catechins improves liver function and fat infiltration in non-alcoholic fatty liver disease (NAFLD) patients: a double-blind placebo-controlled study.
        Int J Mol Med. 2013; 32: 989-994
        • Hofman A.
        • Brusselle G.G.
        • Darwish Murad S.
        • van Duijn C.M.
        • Franco O.H.
        • Goedegebure A.
        • et al.
        The Rotterdam Study: 2016 objectives and design update.
        Eur J Epidemiol. 2015; 30: 661-708
        • Goldbohm R.A.
        • van den Brandt P.A.
        • Brants H.A.
        • van't Veer P.
        • Al M.
        • Sturmans F.
        • et al.
        Validation of a dietary questionnaire used in a large-scale prospective cohort study on diet and cancer.
        Eur J Clin Nutr. 1994; 48: 253-265
        • Feunekes G.I.
        • Van Staveren W.A.
        • De Vries J.H.
        • Burema J.
        • Hautvast J.G.
        Relative and biomarker-based validity of a food-frequency questionnaire estimating intake of fats and cholesterol.
        Am J Clin Nutr. 1993; 58: 489-496
        • van Lee L.
        • Geelen A.
        • van Huysduynen E.J.
        • de Vries J.H.
        • van't Veer P.
        • Feskens E.J.
        The Dutch Healthy Diet index (DHD-index): an instrument to measure adherence to the Dutch Guidelines for a Healthy Diet.
        Nutr J. 2012; 11: 49
        • Boursier J.
        • Zarski J.P.
        • de Ledinghen V.
        • Rousselet M.C.
        • Sturm N.
        • Lebail B.
        • et al.
        Determination of reliability criteria for liver stiffness evaluation by transient elastography.
        Hepatology. 2013; 57: 1182-1191
        • Wong V.W.
        • Vergniol J.
        • Wong G.L.
        • Foucher J.
        • Chan H.L.
        • Le Bail B.
        • et al.
        Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease.
        Hepatology. 2010; 51: 454-462
        • Castera L.
        • Forns X.
        • Alberti A.
        Non-invasive evaluation of liver fibrosis using transient elastography.
        J Hepatol. 2008; 48: 835-847
        • Hamaguchi M.
        • Kojima T.
        • Itoh Y.
        • Harano Y.
        • Fujii K.
        • Nakajima T.
        • et al.
        The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation.
        Am J Gastroenterol. 2007; 102: 2708-2715
        • Grundy S.M.
        • Cleeman J.I.
        • Daniels S.R.
        • Donato K.A.
        • Eckel R.H.
        • Franklin B.A.
        • et al.
        Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement.
        Circulation. 2005; 112: 2735-2752
        • Matthews D.R.
        • Hosker J.P.
        • Rudenski A.S.
        • Naylor B.A.
        • Treacher D.F.
        • Turner R.C.
        Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.
        Diabetologia. 1985; 28: 412-419
        • Willett W.C.
        • Reynolds R.D.
        • Cottrell-Hoehner S.
        • Sampson L.
        • Browne M.L.
        Validation of a semi-quantitative food frequency questionnaire: comparison with a 1-year diet record.
        J Am Diet Assoc. 1987; 87: 43-47
        • Cassinotto C.
        • Boursier J.
        • de Ledinghen V.
        • Lebigot J.
        • Lapuyade B.
        • Cales P.
        • et al.
        Liver stiffness in nonalcoholic fatty liver disease: A comparison of supersonic shear imaging, FibroScan, and ARFI with liver biopsy.
        Hepatology. 2016; 63: 1817-1827
        • Goldbohm R.A.
        • van 't Veer P.
        • van den Brandt P.A.
        • van 't Hof M.A.
        • Brants H.A.
        • Sturmans F.
        • et al.
        Reproducibility of a food frequency questionnaire and stability of dietary habits determined from five annually repeated measurements.
        Eur J Clin Nutr. 1995; 49: 420-429
        • Liu F.
        • Wang X.
        • Wu G.
        • Chen L.
        • Hu P.
        • Ren H.
        • et al.
        Coffee consumption decreases risks for hepatic fibrosis and cirrhosis: a meta-analysis.
        PLoS One. 2015; 10: e0142457
      1. Triantos C, Manolakopoulos S, Smirnidis A. Is caffeine responsible for the hepatoprotective effect of coffee consumption in patients with chronic liver diseases? A multicentre study. AASLD abstract 2013;1.

        • Molloy J.W.
        • Calcagno C.J.
        • Williams C.D.
        • Jones F.J.
        • Torres D.M.
        • Harrison S.A.
        Association of coffee and caffeine consumption with fatty liver disease, nonalcoholic steatohepatitis, and degree of hepatic fibrosis.
        Hepatology. 2012; 55: 429-436
        • Ruhl C.E.
        • Everhart J.E.
        Coffee and tea consumption are associated with a lower incidence of chronic liver disease in the United States.
        Gastroenterology. 2005; 129: 1928-1936
        • Honjo S.
        • Kono S.
        • Coleman M.P.
        • Shinchi K.
        • Sakurai Y.
        • Todoroki I.
        • et al.
        Coffee consumption and serum aminotransferases in middle-aged Japanese men.
        J Clin Epidemiol. 2001; 54: 823-829
        • Carlsen M.H.
        • Halvorsen B.L.
        • Holte K.
        • Bohn S.K.
        • Dragland S.
        • Sampson L.
        • et al.
        The total antioxidant content of more than 3100 foods, beverages, spices, herbs and supplements used worldwide.
        Nutr J. 2010; 9: 3
        • Agrawal S.
        • Duseja A.K.
        Non-alcoholic fatty liver disease: east versus west.
        J Clin Exp Hepatol. 2012; 2: 122-134
        • Shim S.G.
        • Jun D.W.
        • Kim E.K.
        • Saeed W.K.
        • Lee K.N.
        • Lee H.L.
        • et al.
        Caffeine attenuates liver fibrosis via defective adhesion of hepatic stellate cells in cirrhotic model.
        J Gastroenterol Hepatol. 2013; 28: 1877-1884
        • Furtado K.S.
        • Prado M.G.
        • Aguiar E.S.M.A.
        • Dias M.C.
        • Rivelli D.P.
        • Rodrigues M.A.
        • et al.
        Coffee and caffeine protect against liver injury induced by thioacetamide in male Wistar rats.
        Basic Clin Pharmacol Toxicol. 2012; 111: 339-347
        • Vitaglione P.
        • Morisco F.
        • Mazzone G.
        • Amoruso D.C.
        • Ribecco M.T.
        • Romano A.
        • et al.
        Coffee reduces liver damage in a rat model of steatohepatitis: the underlying mechanisms and the role of polyphenols and melanoidins.
        Hepatology. 2010; 52: 1652-1661
        • Rodriguez de Sotillo D.V.
        • Hadley M.
        • Sotillo J.E.
        Insulin receptor exon 11+/− is expressed in Zucker (fa/fa) rats, and chlorogenic acid modifies their plasma insulin and liver protein and DNA.
        J Nutr Biochem. 2006; 17: 63-71
        • Xiao J.
        • Ho C.T.
        • Liong E.C.
        • Nanji A.A.
        • Leung T.M.
        • Lau T.Y.
        • et al.
        Epigallocatechin gallate attenuates fibrosis, oxidative stress, and inflammation in non-alcoholic fatty liver disease rat model through TGF/SMAD, PI3 K/Akt/FoxO1, and NF-kappa B pathways.
        Eur J Nutr. 2014; 53: 187-199
        • Nakamuta M.
        • Higashi N.
        • Kohjima M.
        • Fukushima M.
        • Ohta S.
        • Kotoh K.
        • et al.
        Epigallocatechin-3-gallate, a polyphenol component of green tea, suppresses both collagen production and collagenase activity in hepatic stellate cells.
        Int J Mol Med. 2005; 16: 677-681
        • Friedrich-Rust M.
        • Ong M.F.
        • Martens S.
        • Sarrazin C.
        • Bojunga J.
        • Zeuzem S.
        • et al.
        Performance of transient elastography for the staging of liver fibrosis: a meta-analysis.
        Gastroenterology. 2008; 134: 960-974

      Linked Article

      • Association between beverage consumption and liver fibrosis
        Journal of HepatologyVol. 68Issue 5
        • Preview
          We read with interest the study by Alferink et al.1, which is a questionnaire investigation among 2,424 participants in the general population, of whom 5.2% had significant liver fibrosis (SLF) defined as liver stiffness measurements ≥8.0 kPa. It concluded that the consumption of herbal tea, but not black or green tea, was related to the presence of lower liver stiffness, as was frequent coffee consumption (≥3 cups/day), but not no or moderate coffee consumption (<3 cups/day). Herein, we would like to raise the following issues:
        • Full-Text
        • PDF
      • Herbal tea and liver injury – Tea extract or comedication can make a difference
        Journal of HepatologyVol. 69Issue 2
        • Preview
          With great interest we read the study by Alferink et al.1 and the following letter by Philips and Augustine.2 They raise the valid concern that green tea has been reported to cause severe liver injury ( https://livertox.nih.gov/GreenTea.htm ).
        • Full-Text
        • PDF
      • Herbal tea consumption and the liver – All is not what it seems!
        Journal of HepatologyVol. 68Issue 3
        • Preview
          We read with interest the study by Alferink et al. on the relationship between coffee and herbal tea consumption and liver stiffness in the general population. We congratulate the authors on publishing the largest ever study reporting on the relationship between coffee, tea and liver health in a general population and the only one also reporting on tea intake and liver health. This study was a cross sectional analysis of The Rotterdam Study, a large ongoing population-based cohort of participants in a Dutch suburb.
        • Full-Text
        • PDF
      • Reply to: “Herbal tea consumption and the liver – All is not what is seems!”
        Journal of HepatologyVol. 68Issue 3
        • Preview
          We would like to thank Drs Philips and Augustine for their valuable comments on our study on coffee and tea consumption in relation to liver health in the general population.1,2 In our study we show that both coffee as well as herbal tea are associated with lower liver stiffness independent of many potential confounding factors. In their letter, Philips and Augustine raise the valid concern that papers like ours may convey a general message that consumption of tea containing herbal extracts or other complex mixtures is evidently beneficial and safe.
        • Full-Text
        • PDF
      • Reply to: “Association between beverage consumption and liver fibrosis”
        Journal of HepatologyVol. 68Issue 5
        • Preview
          Thank you for the opportunity to reply to the letter by Huang et al.1 The authors of this letter posed two main questions, which we will address consecutively. First, they questioned why we categorised subtypes of tea (no vs. any) differently from coffee consumption (no, moderate, and frequent). This is simply related to the small number of participants with frequent tea consumption, 91 participants reported frequent green tea consumption and 162 reported frequent herbal tea consumption, which would hamper the ability to perform robust multivariable analyses within subcategories.
        • Full-Text
        • PDF
      • The impact of coffee consumption on fibrosis and steatosis in HIV-HCV co-infected patients
        Journal of HepatologyVol. 68Issue 4
        • Preview
          Alferink et al.1 report novel results regarding the protective effects of coffee and herbal tea consumption on liver stiffness, which is a proxy for liver fibrosis, measured using FibroScan. Their cross-sectional study was nested inside a large population-based cohort of participants aged 45 and older (mean age 66.5 ± 7.4 years) in Rotterdam.
        • Full-Text
        • PDF