Objective: We aimed to use the meta-analysis method to assess the relationship between coffee drinking and all-cause mortality. Design: Categorical and dose-response meta-analyses were conducted using random-effects models. Setting: We systematically searched and identified eligible literature in the PubMed and Scopus databases. Subjects: Seventeen studies including 1 054 571 participants and 131 212 death events from all causes were included in the present study. Results: Seventeen studies were included and evaluated in the meta-analysis. A U-shaped dose-response relationship was found between coffee consumption and all-cause mortality (P for non-linearity < 0·001). Compared with non/occasional coffee drinkers, the relative risks for all-cause mortality were 0·89 (95 % CI 0·85, 0·93) for 1-< 3 cups/d, 0·87 (95 % CI 0·83, 0·91) for 3-< 5 cups/d and 0·90 (95 % CI 0·87, 0·94) for ≥5 cups/d, and the relationship was more marked in females than in males.
Conclusions:The present meta-analysis of prospective cohort studies indicated that light to moderate coffee intake is associated with a reduced risk of death from all causes, particularly in women.Keywords Meta-analysis Coffee All-cause mortality Prospective cohort study Coffee is one of the most popular beverages in the world and the health-related effects of coffee have been frequently studied. Habitual coffee drinking was reported to be inversely related to the risks of type 2 diabetes(1) and chronic liver disease (2) . As a major dietary source of antioxidants, coffee may also help to improve the resistance of LDL to oxidation and reduce oxidative DNA damage (3) . Results from prospective cohort studies regarding the association of habitual coffee drinking with all-cause mortality were inconclusive (4)(5)(6) . O'Keefe et al. (7) recommended that moderate intake of coffee, tending towards two or three to as many as four cups daily, would be a better choice for keeping healthy rather than excessive coffee consumption. Besides, the association of coffee intake with all-cause mortality may differ between men and women. Lopez-Garcia et al. (8) observed that the significant inverse association of coffee drinking with total mortality was attenuated in men when compared with that in women. Similar results were also found in another large cohort study (9) . A recent meta-analysis of prospective cohort studies suggested that moderate coffee intake was associated with a lower risk of CHD in female drinkers but not in men (10) . However, the health-related effects of coffee may not always be in favour of women. Ascherio et al. (11) reported that coffee consumption was associated with reduced mortality from Parkinson's disease in men but not in women due to the interaction between caffeine and use of postmenopausal oestrogens. Therefore, we conducted a meta-analysis of prospective cohort studies to investigate the association of coffee consumption with all-cause mortality and further to elucidate whether this association varied between male and female coffee drinkers.