Good News for Coffee Drinkers

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Actually, this is only good news
for coffee drinkers who also have
late-stage hepatitis C
.  A recent study in Hepatology showed a
possible benefit to coffee consumption in patients with hepatitis C,

First I will show the treatment of the study as shown in the popular
press, then the actual journal article.


Could Stall Liver Disease Progression

By Kristina Fiore, Staff Writer, MedPage Today

Published: October 21, 2009

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of
Medicine, University of California, San Francisco and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse

Drinking three or more cups of coffee daily lowers the risk of liver
disease progression for patients with chronic hepatitis C, researchers

Those who so indulged had a 53% decreased risk of disease progression,
compared with patients who didn't drink coffee, Neal D. Freedman, MD,
of the National Cancer Institute, and colleagues reported in the
November issue of Hepatology.

"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," Freedman said in a statement...


The snippet above is from an article about the study.  The actual
journal article is this one:

Intake Is Associated with Lower Rates of Liver

Progression in Chronic Hepatitis C

Higher coffee consumption has been associated inversely
with the incidence of chronic liver disease in population studies. We
examined the relationship of coffee consumption with liver disease
progression in individuals with advanced hepatitis C-related liver
. Baseline coffee and tea intake were assessed in 766
participants of the Hepatitis C Antiviral Long-Term Treatment against
Cirrhosis (HALT-C) trial
who had hepatitis C-related bridging
fibrosis or cirrhosis on liver biopsy and failed to achieve a sustained
virological response
to peginterferon plus ribavirin treatment.
Participants were followed for 3.8 years for clinical outcomes and, for
those without cirrhosis, a 2-point increase in Ishak fibrosis score on
protocol biopsies. At baseline, higher coffee consumption was
associated with less severe steatosis on biopsy
, lower serum
aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio,
alpha-fetoprotein, insulin, and homeostatic model assessment (HOMA2)
score, and higher albumin (P < 0.05 for all). Two hundred thirty
patients had outcomes. Outcome rates declined with increasing
coffee intake
: 11.1/100 person-years for none, 12.1 for less than 1
cup/day, 8.2 for 1 to fewer than 3 cups/day, and 6.3 for 3 or more
cups/day (P-trend = 0.0011). Relative risks (95% confidence intervals)
were 1.11 (0.76-1.61) for less than 1 cup/day; 0.70 (0.48-1.02) for 1
to fewer than 3 cups/day; and 0.47 (0.27-0.85) for 3 or more cups/day
(P-trend = 0.0003) versus not drinking. Risk estimates did not vary by
treatment assignment or cirrhosis status at baseline. Tea intake was
not associated with outcomes. Conclusion: In a large
prospective study of participants with advanced hepatitis C-related
liver disease, regular coffee consumption was associated with lower
rates of disease progression.

We see a lot of these studies that show THIS is correlated with THAT,
with no convincing data regarding causality.  Then the chorus
sings "Correlation is not causation, tra-la-la."  However, this is
an unusually strong correlation, with an apparent dose-response
relationship.  A 53% reduction in disease progression is a robust
finding.  Consider this:

Treatment with peginterferon and ribavirin for 24-48 weeks
clears virus and resolves chronic hepatitis in approximately half of

So the href="">best
treatment we have, only works half the time.  Plus, a
10-day supply of ribavirin costs $260; a single 1ml vial (180mcg/ml) of
peginterferon costs $606.  You can get some really
good coffee for that kind of money.

Because of the nature of the study, I suspect that the only firm
conclusion that you can draw is that
coffee drinking is not harmful for persons with advanced hep
C.  That
is different than saying it actually is good.  Furthermore, it is
important to notice that the study was done in persons with advanced
hepatitis C who had failed to show adequate response to peginterferon
plus ribavirin treatment.  That is a select population; it simply
is not possible to generalize from this.

The point of the paper is that there are few options available for
these patients, so any glimmer of hope is a good thing.  As the
authors state:

[P]atients ineligible for or unable to tolerate treatment
have few additional options, such that identification of modifiable
risk factors for disease progression is a clinically important issue.


N., Everhart, J., Lindsay, K., Ghany, M., Curto, T., Shiffman, M., Lee,
W., Lok, A., Di Bisceglie, A., Bonkovsky, H., Hoefs, J., Dienstag, J.,
Morishima, C., Abnet, C., Sinha, R., & , . (2009). Coffee intake is
associated with lower rates of liver disease progression in chronic
hepatitis C Hepatology, 50
(5), 1360-1369 DOI: href="">10.1002/hep.23162


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So, all the alcoholics with advanced liver disease, sitting around at AA drinking gallons of coffee turns out to be a good thing.