喝咖啡与降低肝硬度有关：一项全国代表性研究

StephenW

喝咖啡与降低肝硬度有关：一项全国代表性研究

    塞巴斯蒂安·尼岑
    马纳夫·梅塔
    Z. Gordon Jiang
    埃利奥特·B·塔珀

发布时间：2021 年 10 月 5 日DOI：https://doi.org/10.1016/j.cgh.2021.09.042
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背景与目标
咖啡与降低患肝病的风险有关。这种关联受到重要混杂来源的限制，例如回忆偏差、健康用户偏差和肝脏结果或健康的间接测量。我们的目的是在一个具有全国代表性的样本中检查咖啡消费对肝纤维化和脂肪变性的影响。
方法
我们评估了 2017 年至 2018 年全国健康和营养检查调查研究中 4510 名 20 岁及以上的受试者，他们接受了瞬时弹性成像和两次 24 小时饮食回忆检查。我们测试了 9.5 kpa 或更高的肝脏硬度测量值 (LSM) 或受控衰减参数 (CAP) 与咖啡消耗量之间的关联。我们使用不含咖啡因的咖啡和茶作为对照。作为敏感性分析，我们将所有饮料都包括在 1 个模型中，检查了咖啡因消费的影响，并针对 2015 年健康饮食指数和含糖饮料消费作为单独的模型进行了调整。
结果
所描述的研究样本年龄为 48 ± 0.6 岁，73% 超重或肥胖，10.6% 患有糖尿病，47.5% 报告参与剧烈的体育活动，23% 每天喝 2 杯或更多酒精饮料。多变量调整后，咖啡和对照与 CAP 之间没有关联。喝超过 3 杯咖啡但不喝其他饮料的受试者 kPa 降低 0.9（95% CI，-1.6 至 -0.1；P = .03）。超过 3 杯咖啡对 9.5 kpa 或更高的 LSM 具有保护作用（优势比，0.4；95% CI，0.2–1.0；P = .05）。考虑到同一模型中的所有饮料，仅饮用超过 3 杯咖啡仍与 LSM 独立相关（优势比，0.5；95% CI，0.2–0.9；P = .03）。在任何剂量下，咖啡因都与 LSM 没有显着相关性。最后，调整含糖饮料消费量和 2015 年健康饮食指数后，咖啡消费量仍然与较低的 LSM 相关。因此，咖啡消费的保护性质不能归因于咖啡因，并且无论参与者的饮食质量如何，它们都会持续存在。
结论
根据美国成年人的 CAP 衡量，咖啡与较低的肝脏硬度有关，但与脂肪变性无关。
关键词

    NHANES
    脂肪肝
    咖啡因
    肝病

StephenW

Coffee Consumption Is Associated With Lower Liver Stiffness: A Nationally Representative Study

    Sebastian Niezen
    Manaav Mehta
    Z. Gordon Jiang
    Elliot B. Tapper

Published:October 05, 2021DOI:https://doi.org/10.1016/j.cgh.2021.09.042
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Background & Aims
Coffee is associated with a reduced risk of liver disease. This association is limited by important sources of confounding such as recall bias, healthy user bias, and indirect measures of liver outcomes or health. We aimed to examine the impact of coffee consumption with liver fibrosis and steatosis in a nationally representative sample.
Methods
We evaluated 4510 subjects 20 years and older from the 2017 to 2018 National Health and Nutrition Examination Survey study who underwent both transient elastography and two 24-hour dietary recall examinations. We tested the associations between liver stiffness measurements (LSM) of 9.5 kpa or greater or controlled attenuation parameter (CAP) and coffee consumption. We used decaffeinated coffee and tea consumption as controls. As a sensitivity analysis, we included all drinks in 1 model, examined the impact of caffeine consumption, and adjusted for the Healthy Eating Index-2015 and sugar-sweetened beverage consumption as separate models.
Results
The study sample described was aged 48 ± 0.6 years, 73% were overweight or obese, 10.6% had diabetes, 47.5% reported participation in vigorous physical activity, and 23% drank 2 or more alcoholic drinks per day. After multivariate adjustment, there was no association between coffee and controls with CAP. Subjects who drank more than 3 cups of coffee, but not other drinks, had a 0.9 lower kPa (95% CI, -1.6 to -0.1; P = .03). More than 3 cups of coffee were protective for LSM of 9.5 kpa or higher (odds ratio, 0.4; 95% CI, 0.2–1.0; P = .05). Accounting for all beverages in the same model, only consuming more than 3 cups of coffee remained independently associated with LSM (odds ratio, 0.5; 95% CI, 0.2–0.9; P = .03). Caffeine was not associated significantly with LSM at any dose. Finally, adjusting for sugar-sweetened beverage consumption and Healthy Eating Index-2015, coffee consumption remained associated with a lower LSM. The protective nature of coffee consumption therefore is not attributable to caffeine and persists in participants regardless of their diet quality.
Conclusions
Coffee is associated with lower liver stiffness, but not steatosis, as measured by CAP among US adults.
Keywords

    NHANES
    Fatty Liver
    Caffeine
    Liver Disease

StephenW

喝咖啡能让肝脏更健康吗？

一组肝病学家探索咖啡因对肝脏健康的影响。
女人在桌子上喝咖啡的黄色图画动人图，她的肝脏很高兴
Jacob Dwyer，密歇根医学博士。

当人们想到喝太多咖啡时，可能会想到焦虑、血压升高、胃灼热和“紧张不安”。

但是你的肝脏会发生什么？

几十年来，专家们将喝咖啡与降低肝病风险联系起来。但回忆偏见和生活方式因素等因素可能影响了这些发现。

这个想法激发了密歇根医学院内科副教授 Elliot Tapper 医学博士与哈佛医学院的肝脏专家合作，在不考虑外部影响的情况下研究咖啡消费对肝脏健康的影响。他们的研究结果发表在《临床胃肠病学和肝病学》上。

该团队使用国家健康和营养检查调查 (NHANES) 对总共 4,510 名年龄在 20 岁或以上且没有病毒性肝炎的人进行了检查。每个合格的参与者还进行了完整的弹性成像检查。

“重要的是要认识到有多种方法可以了解某人肝脏的健康状况，” Tapper 说。 “有一些血液测试可以提供线索，但它们既不敏感也不具体。还有一些肝活检更具侵入性，但很难以这种方式研究整个人群。”

因此，Tapper 和他的团队决定使用弹性成像检查来“从字面上评估肝脏的弹性，揭示其僵硬程度。因为传统上，肝脏越僵硬，就越不健康。”

该检查使用与超声波相当的技术，并通过观察穿过肝脏的运动波来测量肝脏硬度。

“可以这么说，肝脏在摇晃，它的运动速度被解释为它的僵硬，”塔珀说。 “这一切都通过皮肤发生，探针穿过肋骨区域，然后触发肝脏内的运动波。”

该团队将含咖啡因的咖啡与不含咖啡因的咖啡和茶进行了比较。他们还针对参与者群体中的含糖饮料消费和生活方式因素等因素进行了调整。

“当患者被诊断出患有肝病时，他们经常会向他们的医生询问饮食调整，”塔珀说。 “例如，'我应该吃什么或不吃什么，喝什么或不喝什么，才能好起来？'”

虽然这些问题的答案通常集中在全食物和蔬菜上，但也有多年关于咖啡消费和健康肝脏关联的研究。

然而，Tapper 指出相关性不是因果关系，这些数据存在“回忆偏差、健康用户偏差以及肝脏结果或健康的间接测量”。

因此，对于 Tapper 和他的同事来说，通过直接评估他们的肝脏健康来检查他们的研究参与者的最高质量的营养信息非常重要。
结果

研究小组发现，当考虑生活方式因素时，每天喝三杯以上咖啡的人肝脏僵硬程度降低。他们还发现，这些人经历了与肝脏僵硬增加相关的风险降低。

“虽然喝咖啡与肝脏僵硬升高的风险较低有关，但这不包括脂肪肝或脂肪变性，”塔珀说。 “总的来说，我们的研究结果表明，如果咖啡对肝脏有影响，可能是通过减少纤维化或疤痕组织来实现的”

Tapper 补充说，他希望这项研究能够揭示美国慢性肝病的负担，即使个人可能不一定知道他们患有慢性肝病。

“我们的研究揭示了寻找这种情况的重要性，”他说。 “这也让我们可以与可能想要做一些额外事情来帮助肝脏的患者进行讨论。它强调了对我们的患者（作为肝脏专家和医疗保健提供者）进行完整营养评估的价值。如果像喝咖啡这样简单的事情可以减少肝癌或肝硬化的症状，那么我们迫切需要在试验中进一步探索这个话题。”

引用的论文：“咖啡消费与肝脏硬度降低有关：一项全国代表性的研究，”临床胃肠病学和肝病学。 DOI：10.1016/j.cgh.2021.09.042

StephenW

Can drinking coffee lead to a healthier liver?

A team of hepatologists explore the effects of caffeine on liver health.
moving graphic of yellow drawing of woman sipping coffee at a table and her liver is happy
Jacob Dwyer, Michigan Medicine.

Anxiety, increased blood pressure, heartburn and ‘the jitters’ may come to mind when people think of consuming too much coffee.

But what happens to your liver?

For decades, experts have associated coffee consumption with a reduced risk of liver disease. But things like recall bias and lifestyle factors have likely impacted these findings.  

This notion inspired Elliot Tapper, M.D., an associate professor of internal medicine at Michigan Medicine, to team up with liver specialists from Harvard Medical School and study the effects of coffee consumption on liver health without including external influences. Their findings were published in Clinical Gastroenterology and Hepatology.

The team used the National Health and Nutrition Examination Survey, or NHANES, to examine a total of 4,510 individuals that were aged 20 years or older and did not have viral hepatitis. Each qualifying participant also had a complete elastography exam.

“It’s important to recognize that there are multiple ways to understand the health of someone’s liver,” said Tapper. “There are blood tests that can provide clues, but they’re neither sensitive nor specific. There are also liver biopsies that are much more invasive, but it’s difficult to study an entire population this way.”

Therefore, Tapper and his team decided to use the elastography exam to “literally assesses the elasticity of the liver, revealing its stiffness. Because traditionally, the stiffer the liver, the unhealthier it is.”

The exam uses technology comparable to that of an ultrasound and measures liver stiffness by observing a wave of movement that travels through the liver.

“The liver is jiggled, so to speak, and the speed of its movement is interpreted as its stiffness,” said Tapper. “This all happens through the skin, with a probe going through the rib area which then triggers the wave of movement within the liver.”

The team compared caffeinated coffee to decaffeinated coffee and tea. They also adjusted for things like sugar-sweetened beverage consumption and lifestyle factors within their pool of participants.

“When patients are diagnosed with liver disease, they’ll often ask their physicians about dietary modifications,” said Tapper. “For example, ‘What should I eat or not eat, drink or not drink, in order to get better?’”

While the answer to these questions usually focuses on whole foods and vegetables, there also have been many years of research around coffee consumption and associations with healthier livers.

However, Tapper noted that correlation is not causation and these data suffer from “recall bias, healthy-user bias, and indirect measures of liver outcomes or health.”

Therefore, it was important for Tapper and his colleagues to examine the highest quality nutritional information for their study participants through a direct assessment of their liver health.  
The results

The team found that individuals who consumed more than three cups of coffee a day showed reduced levels of liver stiffness when lifestyle factors were considered. They also found that these same individuals experienced reduced risks associated with increased liver stiffness.

“While coffee consumption was associated with a lower risk of elevated liver stiffness, this didn’t include fatty liver disease, or steatosis,” said Tapper. “Overall, our findings showed that if coffee has an effect on the liver, it is likely by reducing fibrosis, or scar tissue”

Tapper added that he hopes that this study will shine a light on the burden of chronic liver disease in the United States, even when individuals may not necessarily know that they have it.

“Our research revealed the importance of looking for this condition,” he said. “It also gives us something to discuss with our patients who may want to do something extra to help their livers. It highlights the value of conducting a complete nutritional assessment with our patients, as liver specialists and health care providers. If something as simple as consuming coffee can reduce liver cancer or symptoms of cirrhosis, there is a critical need for us to explore this topic further in trials.”

Paper cited: “Coffee consumption is associated with lower liver stiffness: a nationally representative study,” Clinical Gastroenterology and Hepatology. DOI: 10.1016/j.cgh.2021.09.042