1. Coffee and Tea Intake Appears Protective Against Chronic Liver Disease Slideset on: Ruhl CE, Everhart JE. Coffee and tea consumption are associated with a lower incidence of chronic liver disease in the United States. Gastroenterology. 2005;129: 1928-1936.

2. clinicaloptions.com/hep Coffee/tea consumption and incidence of chronic liver disease Background and Rationale  Studies of liver enzymes suggest that coffee or caffeine consumption may reduce liver injury  Various international studies found higher coffee consumption to be associated with lower incidence of cirrhosis and cirrhosis-related death  Current study assessed relationship between coffee and tea consumption with incidence of chronic liver disease in general US population Ruhl CE, et al. Gastroenterology. 2005;129:1928-1936.

3. clinicaloptions.com/hep Coffee/tea consumption and incidence of chronic liver disease Study Design  National Health and Nutrition Examination Survey (NHANES I)—1971-1975 –Data included demographics; coffee, tea, or alcohol consumption; health status; and laboratory measures –Follow-up data identified hospitalizations, nursing home admissions, and deaths due to chronic liver disease  NHANES I Epidemiologic Follow-up Study (NHEFS)—1982-1984 –Data included more detailed information about caffeine consumption, health status (diabetes), and cigarette and alcohol use Ruhl CE, et al. Gastroenterology. 2005;129:1928-1936.

4. clinicaloptions.com/hep Coffee/tea consumption and incidence of chronic liver disease Study Design (cont’d)  Exclusion criteria –History of jaundice – Serum albumin < 3.0 g/dL –Hepatomegaly or splenomegaly on abdominal examination –Missing data for coffee/tea consumption –Facility stay for chronic liver disease between NHANES I and 1982-1984 examination (for NHEFS only) –Doctor-diagnosed cirrhosis at any time (for NHEFS only)  Median follow-up for NHANES I: 19.0 years (0.02-22.1)  Median follow-up for NHEFS: 9.1 years (0.01-11.1) Ruhl CE, et al. Gastroenterology. 2005;129:1928-1936.

5. clinicaloptions.com/hep Coffee/tea consumption and incidence of chronic liver disease Daily Coffee/Tea Intake Lowered Incidence of Chronic Liver Disease  Lower incidence of liver disease associated with higher daily consumption of coffee/tea (P =.002 for trend)  Other factors associated with lower incidence –< 40 years of age– < 1 alcoholic drink/day –Transferrin saturation ≤ 50%– Female sex –Skin-fold ratio < 0.8 – No diagnosed diabetes Coffee and Tea Consumption, Cups/Day Chronic Liver Disease, n Cumulative Incidence of Chronic Liver Disease, % Unadjusted HR (95% CI) < 1221.81.0 1-2571.60.84 (0.52-1.40) > 2291.10.46 (0.26-0.80) Ruhl CE, et al. Gastroenterology. 2005;129:1928-1936.

6. clinicaloptions.com/hep Coffee/tea consumption and incidence of chronic liver disease Multivariate-Adjusted Analysis  Persons considered to be at high risk for chronic liver disease had risk 2.7 times higher than those at low risk  Persons at high risk had ≥ 1 of following –> 2 alcoholic drinks/day – Transferrin saturation > 50% –Diagnosed diabetes – BMI ≥ 30 mg/m 2 –Subscapular-to-triceps skin-fold ratio ≥ 1.2 Ruhl CE, et al. Gastroenterology. 2005;129:1928-1936.

7. clinicaloptions.com/hep Coffee/tea consumption and incidence of chronic liver disease Multivariate-adjusted Analysis Coffee and Tea Consumption, Cups/DayChronic Liver Disease, n Adjusted HR (95% CI) P Value All participants.003  < 1221.0  1-2560.79 (0.48-1.30)  > 2280.43 (0.24-0.78) Persons at high risk for chronic liver disease<.001  ≤ 2651.0  > 2180.40 (0.23-0.68) Persons at low risk for chronic liver disease.63  ≤ 2131.0  > 2101.2 (0.52-3.00)  No protective effect of coffee/tea consumption observed for individuals at low risk for chronic liver disease Ruhl CE, et al. Gastroenterology. 2005;129:1928-1936.

8. clinicaloptions.com/hep Coffee/tea consumption and incidence of chronic liver disease Key Conclusions  Consuming > 2 cups of coffee or tea daily significantly lowered risk for developing chronic liver disease among individuals otherwise at high risk –Persons at high risk for liver disease who drank > 2 cups coffee/tea daily had 60% lower risk for developing chronic liver disease than those who drank < 2 cups daily  Unknown whether protective effects due to caffeine or other compounds in coffee/tea –No protective effect from decaffeinated coffee suggested caffeine may be partially responsible Ruhl CE, et al. Gastroenterology. 2005;129:1928-1936.