Alcohol, Smoking, Cofee, and Cirrhosis

Abstract

Since most heavy drinkers do not develop alcoholic cirrhosis, other causes or predisposing factors are probable. The authors studied traits of 128,934 adults who underwent health examinations at the Oakland and San Francisco, California, facilities of the Kaiser Permanente Medical Care Program from January 1978 to December 1985 in relation to subsequent hospitalization or death from cirrhosis of the liver. In analyses adjusted for nine covariates, past and current alcohol drinking were strongly related to cirrhosis risk, but usual choice of alcoholic beverage had no independent relation. Cigarette smoking was independently related to risk of alcoholic cirrhosis, with cigarette smokers of a pack or more per day at trebled risk compared with lifelong nonsmokers. Coffee drinking, but not tea drinking, was inversely related to alcoholic cirrhosis risk, with persons who drank four or more cups per day at one-fifth the risk of noncoffee drinkers. This inverse relation between coffee consumption and risk of alcoholic cirrhosis was consistent in many subsets, including persons free of gastrointestinal disease and those with 5 or more years before hospitalization or death. Cigarette smoking and coffee consumption were not consistently related to risk of hospitalization or death for nonalcoholic cirrhosis. These data could mean that cigarette smoking promotes alcoholic cirrhosis and that coffee drinking might be protective.

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

“…Cohort studies performed in the USA and Northern Europe all showed an increased risk of developing cirrhosis or HCC due to alcohol drinking, although some of them found a doseeffect relationship (Klatsky and Armstrong, 1992;Becker et al, 2002) whereas others found a threshold effect of 50-75 g/day, after which the risk does not increase further (Sorensen et al, 1998;Kamper-Jorgensen et al, 2004). Various factors may have caused these contrasting results, mainly confounding by other factors, inaccuracy in estimating the level of intake during follow-up, and the low power of the studies.…”

“…Furthermore, a USA cohort study found an increased risk of alcoholic cirrhosis among cigarette smokers as compared to non-smokers (Klatsky and Armstrong, 1992). …”

“…Some Japanese studies found that coffee inhibits the induction of GGT in the liver by alcohol consumption (Tanaka et al, 1998) and that the inverse relation between coffee drinking and serum gamma-glutamyltransferase was progressively steeper with increasing alcohol consumption (Tanaka et al, 1998;Honjo et al, 1999). Secondly, some cohort and case-control studies performed in various countries, including Italy, found an inverse relation between coffee consumption and risk of cirrhosis (Klatsky and Armstrong, 1992;Klatsky et al, 1993;Corrao et al, 2001, Gallus et al, 2002bTverdal and Skurtveit, 2003). It is worth noting that both the cohort and the case-control studies found an inverse dose-effect relationship between coffee intake and cirrhosis, and one of them found that the association was not attributable to caffeine (Corrao et al, 2001).…”

Does coffee protect against hepatocellular carcinoma?

“…The possible relation between coffee drinking and the risk of several cancers, particularly of cancers of the urinary bladder, pancreas and colorectum, has been widely investigated. These have shown a direct relation with bladder, an inverse one with colorectum, but no consistent association with other major sites, including liver cancer (IARC, 1991;Tavani and La Vecchia, 2000).Coffee drinking has been inversely related to the risk of liver cirrhosis in several studies (Klatsky and Armstrong, 1992;Klatsky et al, 1993;Corrao et al, 1994Corrao et al, , 2001Gallus et al, 2002). Although cirrhosis is a major correlate of hepatocellular carcinoma (Adami et al, 1992;La Vecchia et al, 1998, Kuper et al, 2000, the relation between coffee drinking and risk of hepatocellular carcinoma has been examined in only two studies which provided, however, no definite results.…”

Adenosine in fibrosis

“…It is possible, therefore, that the fibrosing effect of methotrexate in the liver may also be mediated through the release of adenosine. It is worth noting that there has been extensive epidemiologic demonstration of the protective effects of coffee in liver cirrhosis [76, 77]. It is possible that these protective effects may be attributable to caffeine, an effective and nonselective antagonist of adenosine receptors.…”