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Coffee consumption and risk chronic diseases: the epidemiological evidence

Coffee consumption and risk chronic diseases: the epidemiological evidence. Rob M. van Dam, PhD. Channing Laboratory Brigham and Women’s Hospital, and Harvard Medical School. Department of Nutrition Harvard School of Public Health. Contribution of coffee to dietary intake.

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Coffee consumption and risk chronic diseases: the epidemiological evidence

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  1. Coffee consumption and risk chronic diseases:the epidemiological evidence Rob M. van Dam, PhD Channing Laboratory Brigham and Women’s Hospital, and Harvard Medical School Department of Nutrition Harvard School of Public Health

  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 1995;43:2167-72)

  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 it’s 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)

  7. 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 Jackman et al, 1996 Perkins & Williams, 1975 0 0 20 40 60 80 100 Placebo/Decaf (min)

  8. Graham et al. JAP 85: 883-889, 1998 ** Coffee is not just caffeine

  9. 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: • N=84,488 women • 20 years of follow-up • 2254 incident cases of CHD • Health Professionals Follow-up Study: • N=44,005 men • 14 years of follow-up • 2173 incident cases of CHD Lopez-Garcia E, et al. Circulation 2006

  14. 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

  17. 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)

  19. Studies of habitual coffee consumption and risk of type 2 diabetes

  20. Caffeine Effect of Caffeine on Insulin Sensitivity in Obesity and Type 2 Diabetes Caffeine significantly lower than placebo in all trials (P <0.05) 20 * Greater than pre-treatment (P <0.05) * * 15 Glucose Uptake (mg/kgSM.min-1) 10 Placebo 5 0 Pre Pre Post Post Pre Post Lean Obese T2D Glucose uptake was measured 4 days post exercise

  21. Thong & Graham(Lean) Graham et al (Lean) Battram et al (Lean - CAF) Petrie (Obese - with wt loss) Battram et al (Lean - Coffee) Chown et al (Obese) Robinson et al (Type 2 diabetics) Petrie (Obese - before wt loss) 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 22:1462, 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) t(min) = -15 0 15 30 45 60 90 120 150 180 185 200 215 230 245 275 305 tchallenge2 = 0 15 30 45 60 90 120 Catecholamines Methylxanthines CHO Challenge #1 CHO Challenge #2 (given AFTER blood sample @ 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)

  23. Insulin 35000 550 CC 30000 500 DC W 25000 450 20000 400 Insulin (pM/3h) 350 15000 Insulin (pM) 300 10000 250 5000 200 0 CC DC W 150 Treatment 100 50 0 -30 0 30 60 90 120 150 180 Time (min) Results: First Meal

  24. 7.5 140 a CC 7.0 120 DC W 6.5 a 100 6.0 80 5.5 Glucose (mM) Glucose (mM/3h) 5.0 60 4.5 b 40 4.0 20 3.5 3.0 0 -30 0 30 60 90 120 150 180 CC DC W Time (min) Treatment First Meal: Glucose

  25. 550 550 a a 500 CC 500 DC W 450 40000 450 400 400 b b b 350 b 350 30000 Insulin (pM/2h) 300 Insulin (pM) 300 250 250 20000 200 200 150 150 10000 100 100 50 50 0 CC W DC 0 0 0 30 60 90 120 150 180 210 240 270 300 330 -30 Treatment Time (min) Second Meal: Insulin

  26. 7.5 7.5 CC DC 7.0 7.0 W 300 6.5 6.5 250 a 6.0 6.0 200 5.5 5.5 Glucose (mM) Glucose (mM/2h) 150 5.0 5.0 b 100 4.5 4.5 b 4.0 4.0 50 3.5 3.5 0 3.0 3.0 CC DC W Treatment -30 0 30 60 90 120 150 180 210 240 270 300 330 Time (min) Second Meal: Glucose

  27. Coffee consumption and incidence of type 2 diabetesin the Netherlands   Van Dam RM, Feskens EJ. Lancet 2002.

  28. 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 0.65 (0.54-0.78) Total (95% CI) 0.1 0.2 0.5 1 2 5 10 Favours high coffee Favours low coffee

  31. 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 trend=0.001 P trend <0.0001

  36. Change in caffeinated coffee consumption and change in weight over 12 years Lopez-Garcia E, et al. Am J Clin Nutr 2006;83:674-80

  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 2006;83:674-80

  38. Coffee, caffeine, and risk of type 2 diabetes in U.S. women

  39. 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

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

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