Journal Club

1. Journal Club MeenaMeka MD

2. Topic • Association of Coffee Drinking with Total and Cause-Specific Mortality

3. Background • Coffee is one of the most widely consumed beverages, but the association between coffee consumption and the risk of death remains unclear.

4. PICO Question • Patient • Intervention • Control • Outcome

5. PICO • Patient:

6. PICO Question • Intervention

7. PICO Question • Control:

8. PICO Question • Outcome

9. The Article • Association of Coffee Drinking with Total and Cause Specific Mortality. • New England Journal of Medicine • 2012;366:1891-1904

10. The Article • Original Research • Prospective, multicenter • Journal – peer reviewed, general internal medicine • Sites: multicenter • Patients: 229,118 men and 173,141 women

11. Patient Criteria • Exclusion • Persons whose questionnaires were completed by others • Cancer • Heart disease • Previous stroke • Inclusion • 50-71years

12. Other exclusions • Persons who did not provide information on coffee use • Extremely low or high caloric consumption • Those who died before completed questionnaire was received

13. Study Population • 617,119 AARP members 50-71 years of age returned a comprehensive questionnaire assessing diet and lifestyle • Participants resided in 6 states, CA, FL, LO, NJ, NC, PN, and 2 metropolitan areas, Atlanta and Detroit • 566,401 completed the questionnaire satisfactorily

14. Methods • Participants completed the baseline questionnaire that assessed demographic and lifestyle characteristics and 124 dietary items • Consumption of fruits, vegetables, red meat, white meat, unsaturated fat were adjusted for total energy intake with the use of the nutrient density approach • Coffee consumption was assessed according to 10 frequency categories ranging from 0-6 or more cups a day

15. Methods • 96.5% of coffee drinkers provided information on whether they drank caffeinated or decaffeinated coffee more than half the time • Participants were followed from baseline (95-96) until the date of death or 12/31/08. • Coffee consumption was tabulated according to a number of dietary and lifestyle factors • Hazard rations and 95% confidence intervals for mortality associated with coffee consumption were estimated with Cox proportional hazards regression models, with person-years as the underlying time metric

16. Methods • Risk estimates were presented seperately for men and women • Multivariate models were adjusted for: • Age, BMI, race/ethnicity, level of education, alcohol consumption, number of cigarettes smoked daily, use or nonuse of pipes or cigars, time of smoking cessation, health status , presence or absence of diabetes, marital status, level of physical activity, total energy intake, dietary consumption, vitamin supplementation , history of cancer in first degree relative and for women you of postmenopausal hormone therapy

17. Results • Coffee consumption at baseline was associated with several other dietary and lifestyle factors • As compared with persons who did not drink coffee, coffee drinkers were more likely to smoke cigarettes and consume more then 3 alcoholic drinks per day … and they consumed more red meat

18. Results • Coffee drinkers also tended to have a lower level of education; were less likely to engage in vigorous activity and reported lower levels of consumption of fruits, vegetables and white meat • However, coffee drinkers, especially women who drank coffee, were less likely to report having diabetes. • About 2/3 of coffee drinkers reported drinking predominantly caffeinated coffee

19. Results

27. Author’s Conclusion

28. Evaluation

29. Statistics Discussion

30. Questions?