Joint influence of alcohol, tobacco, and coffee on biological markers of heavy drinking in alcoholics

Inverse associations of total and decaffeinated coffee with liver enzyme levels in National Health and Nutrition Examination Survey 1999-2010

Coffee may have hepatoprotective effects and higher coffee consumption has been associated inversely with levels of liver enzymatic markers. However, it is unclear whether decaffeinated coffee is also associated with liver enzymes. The study population included 27,793 participants, age 20 or older, in the U.S. National Health and Nutrition Examination Survey (1999-2010). Coffee intake was evaluated by 24-hour dietary recall. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transaminase (GGT) were measured. We examined the relationship between coffee intake and enzymatic levels using weighted multiple variable logistic (abnormally elevated levels of enzymes) and linear regression (continuous enzymatic levels). Total coffee consumption was inversely associated with abnormal levels of all four liver enzymes and continuous levels of AST, ALP, and GGT. Compared to those reporting no coffee consumption, participants reporting ≥ 3 cups per day had an odds ratio (OR; 95% confidence interval [CI]) of 0.75 (0.63, 0.89), 0.82 (0.68, 0.98), 0.73 (0.55, 0.95), and 0.69 (0.57, 0.83) for abnormal levels of ALT, AST, ALP, and GGT, respectively. Similar inverse associations were found with decaffeinated coffee intake and abnormal levels of ALT (OR (≥ 2 vs 0 cup/d): 0.62 [0.41, 0.94]), AST (0.74 [0.49, 1.11]), and GGT (0.70 [0.49-1.00]).

CONCLUSION

Higher intakes of coffee, regardless of its caffeine content, were associated with lower levels of liver enzymes.

Relation of coffee consumption and serum liver enzymes in Japanese men and women with reference to effect modification of alcohol use and body mass index

OBJECTIVE

Previous studies have shown that coffee consumption is inversely related to serum levels of liver enzymes such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT), but few have addressed the relation in women and effect modifications of alcohol use and obesity. We examined the association of coffee and green tea consumption with serum activities of liver enzymes in free-living Japanese men and women, focusing on sex difference and effect modifications of alcohol and obesity.

MATERIAL AND METHODS

The data were derived from the baseline survey of the Kyushu University Fukuoka Cohort Study, and included 12,020 Japanese men and women aged 49-76 years who were free of chronic liver diseases.

RESULTS

There was an inverse association between coffee consumption and elevated ALT in men, and the association between the two was weaker in women. In the analyses stratified by aminotransferases category, inverse associations of coffee consumption with serum activities of liver enzymes were observed in both men and women within the whole range and among those with aminotransferases within the reference range (ALT/AST <or=40 IU/L for men and ALT/AST <or=30 IU/L for women). Inverse associations of coffee with liver enzymes were more evident in those with high alcohol consumption and in those with low body mass index.

CONCLUSIONS

Coffee drinking probably confers protection against alcohol-related increase in liver enzymes.

Coffee: good, bad, or just fun? A critical review of coffee's effects on liver enzymes

Coffee consumption is a regular part of daily life throughout the world. Research into the effects of coffee on human health is ongoing, but a recent study suggests that coffee and caffeine consumption can reduce the risk of elevated alanine aminotransferase activity in individuals at high risk for liver disease. This review will analyze the results of that study in light of the current literature.

Hyper-anxiety in early sobriety: psychopharmacological treatment strategies

The importance of recognizing and treating anxiety disorders that co-occur with alcohol use disorders should not be underestimated, whether the anxiety is state (a transient condition) or trait (a chronic disorder). This article will discuss hyper-anxiety, a term the authors use to describe the uncomfortable, excessively anxious state that contributes to relapse. In addition, psychopharmacological strategies for relief of hyper-anxiety are suggested, and implications for recovery are discussed.

Blood pressure response to chronic intake of coffee and caffeine: a meta-analysis of randomized controlled trials

PURPOSE

Coffee is a widely consumed beverage and small health effects of substances in coffee may have large public health consequences. It has been suggested that caffeine in coffee increases the risk of hypertension. We performed a meta-analysis of randomized controlled trials of coffee or caffeine and blood pressure (BP).

DATA IDENTIFICATION

BP trials of coffee or caffeine published between January 1966 and January 2003 were identified through literature databases and manual search.

STUDY SELECTION

A total of 16 studies with a randomized, controlled design and at least 7 days of intervention was selected, comprising 25 strata and 1010 subjects.

DATA EXTRACTION

Two persons independently obtained data on sample size, type and duration of intervention, changes in BP and heart rate (HR), and subjects' characteristics for each trial. Meta-analysis was performed using a random-effects model.

RESULTS

A significant rise of 2.04 mmHg [95% confidence interval (CI), 1.10-2.99] in systolic BP and 0.73 mmHg (95% CI, 0.14-1.31) in diastolic BP was found after pooling of coffee and caffeine trials. When coffee trials (n = 18, median intake: 725 ml/day) and caffeine trials (n = 7, median dose: 410 mg/day) were analysed separately, BP elevations appeared to be larger for caffeine [systolic: 4.16 mmHg (2.13-6.20); diastolic: 2.41 mmHg (0.98-3.84)] than for coffee [systolic: 1.22 mmHg (0.52-1.92) and diastolic: 0.49 mmHg (-0.06-1.04)]. Effects on HR were negligible.

CONCLUSIONS

Regular caffeine intake increases BP. When ingested through coffee, however, the blood pressure effect of caffeine is small.

Immunological and hematological effects observed in B6C3F1 mice exposed to JP-8 jet fuel for 14 days

JP-8 is the primary jet fuel used by the U.S. Air Force and NATO allies. Exposure is likely to be widespread and to include both military and aviation industry personnel as well as residents living near fuel contaminated sites. This study examines the effects of JP-8 on humoral and cell-mediated and hematological parameters. A suite of immunotoxicological endpoints was evaluated in adult female B6C3F1 mice gavaged with JP-8 (in an olive oil carrier) ranging from 250-2500 mg/kg/d for 14 d. One day following the last exposure, significant increases in liver mass were detected beginning at exposure levels of 1000 mg/kg/d, while thymic mass was decreased at exposure levels of 1500 mg/kg/d and above. Decreases in thymic cellularity, however, were only observed at exposure levels of 2000 mg/kg/d and above. Mean corpuscular volume was increased (1500-2500 mg/kg/d), while the hematocrit, hemoglobin concentration, and red blood cell count were decreased only at the 2500 mg/kg/d exposure level. Natural killer cell (NK) activity and T- and B-cell proliferation were not altered. Decreases in the plaque-forming cell (PFC) response were dose responsive at levels of 500 mg/kg/d and greater, while unexpectedly, serum levels of anti-SRBC immunoglobulin M (IgM) were not altered. Alterations were detected in thymic and splenic CD4/8 subpopulations, and proliferative responses of bone marrow progenitor cells were enhanced in mice exposed to 2000 mg/kg/d of JP-8. This study establishes that humoral immune function is impaired with lower exposure levels of JP-8 than are required to affect primary and secondary immune organ weights and cellularities, CD4/8 subpopulations, and hematological endpoints.

Biological markers in alcoholism

Alcohol biomarkers include tests indicative of acute or chronic alcohol consumption (state markers), and markers of a genetic predisposition to develop alcohol dependence after chronic exposure (trait markers). While a comprehensive trait marker for alcohol dependence has not been identified, a number of successful state markers for monitoring drinking status are used clinically. These tests provide direct or indirect ways to estimate the amounts of alcohol consumed and the duration of ingestion, and to detect any harmful effects on body functions resulting from long-term misuse. The most obvious method to prove recent drinking is by demonstrating the presence of ethanol in body fluids or breath, but, because ethanol is cleared fairly rapidly from the body, this method is limited to detect only very recent drinking. Measurement of urinary 5-hydroxytryptophol or ethyl glucuronide provide more sensitive methods to disclose recent drinking, because their washout constants are much longer than for ethanol. The liver functions test (GGT, AST and ALT in serum) and the mean corpuscular volume of erythrocytes (MCV) are among the standard diagnostic tools used to identify chronic alcohol exposure. The main disadvantage with these measures is that they have low sensitivity for recent excessive intake, and that raised levels may result from several causes besides heavy drinking, implying a low specificity for alcohol. Carbohydrate-deficient transferrin (CDT), which refers to changes in the carbohydrate composition of serum transferrin, is a more specific marker for identifying excessive alcohol consumption and monitoring abstinence during outpatient treatment. The alcohol biomarkers improves knowledge of drinking patterns in both individuals and populations, and they are also valuable tools for the objective evaluation of treatment efforts. Alcohol markers have, for example, found uses in early identification of at-risk and harmful drinking, and they help to monitor abstinence and relapse in response to outpatient treatment.

Traditional markers of excessive alcohol use

AIMS

The blood tests used traditionally as markers of excessive drinking are the liver enzymes, gamma glutamyltransferase (GGT), aspartate aminotransferase (AST) and alanine aminotransferase (ALT), and the red blood cell volume (mean corpuscular volume: MCV). Here we review the nature of these markers' association with alcohol use, their practical application in detecting, assessing or monitoring drinking and increases in understanding of these markers in the past 10 years.

DESIGN

Articles were identified via Medline search and perusal of bibliographies.

FINDINGS

The conventional markers have imperfect sensitivity and specificity, but have an added clinical role in the detection of complications of drinking, and of comorbid conditions that may increase risk of drinking. GGT may in part be a marker of the oxidative stress associated with ethanol metabolism. Markers are more likely to be elevated in those aged more than 30 years and in regular drinkers with a longer drinking history. The markers may be useful in opportunistic case finding, in motivating patients to change drinking and in monitoring treatment response. Increased prevalence of obesity and hepatitis C must be considered in interpretation of liver enzyme results. The liver enzymes are prognostic indicators for several medical conditions and for mortality.

CONCLUSIONS

These conventional tests are widely available and relatively inexpensive. While having limited sensitivity and specificity in detection of excessive drinking, they also provide valuable data on complications of drinking, comorbid conditions that may be affected by drinking and, in some cases, prognosis.

Does coffee protect against hepatocellular carcinoma?

We analysed the relation between coffee consumption and hepatocellular carcinoma in two case-control studies conducted between 1984 and 1998 in Italy and Greece, including 834 cases and 1912 controls. Compared to non coffee drinkers, the multivariate odds ratio was 0.7 for drinkers of three or more cups per day.

Does coffee protect against liver cirrhosis?

PURPOSE

To evaluate the relation between consumption of coffee and other methylxanthine-containing beverages and liver cirrhosis.

METHODS

A hospital-based case-control study of digestive tract and liver diseases was conducted in Greater Milan, Italy, including 101 cases with liver cirrhosis and 1538 controls.

RESULTS

Compared with coffee non-drinkers, the multivariate odds ratio (OR) was 0.77 for one cup of coffee per day, 0.57 for two, and 0.29 for three or more. The OR for 40 years of coffee consumption or more was 0.45. Trends in risk were significant for both number of cups and duration of coffee drinking. No significant association was observed with decaffeinated coffee, tea and cola-containing beverages. The relation between coffee consumption and liver cirrhosis was not attributable to confounding and was observed across strata of tobacco, alcohol, and other major covariates of interest. In particular, an inverse relation was observed also in subjects reporting moderate alcohol drinking.

CONCLUSIONS

The present study confirms, and further quantifies, the existence of an inverse association between coffee consumption and liver cirrhosis. However, the metabolism of caffeine is impaired in fasting subjects with liver cirrhosis, and the association could be due to a reduction of coffee drinking in subjects with liver cirrhosis.

Coffee, caffeine, and the risk of liver cirrhosis

PURPOSE

To evaluate the effect of the consumption of caffeine-containing beverages on the risk of symptomatic liver cirrhosis (LC).

METHODS

From 1994 to 1998, all the consecutive cirrhotic inpatients admitted in 19 collaborative hospitals for signs of liver decompensation in whom the diagnosis of liver cirrhosis was made for the first time (274 cases) and one or two gender, age, and place of residence pair matched individuals (458 controls) were recruited. Data on years of education, lifetime cigarette use, lifetime intake of alcohol- and caffeine-containing beverages, usual consumption of 180 food items, and on markers of hepatitis B and C viral infection were collected.

RESULTS

A statistically significant trend toward lowered cirrhosis risk with increasing exposure to coffee was observed. The LC odds ratios decreased from 1.0 (reference category: lifetime abstainers from coffee) to 0.47 (95% confidence interval: 0.20, 1.10), 0.23 (0.10, 0.53), 0.21 (0.06, 0.74), and 0.16 (0.05, 0.50) in 1, 2, 3, and 4 or more cups of coffee drinkers, respectively. There was no convincing evidence that coffee consumption modifies the effects of the known risk factors of liver cirrhosis (alcohol intake and viruses infection).

CONCLUSIONS

These findings support the hypothesis that coffee, but not other beverages containing caffeine, may inhibit the onset of alcoholic and nonalcoholic liver cirrhosis.

Gamma glutamyl transferase

Serum gamma-glutamyl transferase (GGT) has been widely used as an index of liver dysfunction and marker of alcohol intake. The last few years have seen improvements in these areas and advances in understanding of its physiological role in counteracting oxidative stress by breaking down extracellular glutathione and making its component amino acids available to the cells. Conditions that increase serum GGT, such as obstructive liver disease, high alcohol consumption, and use of enzyme-inducing drugs, lead to increased free radical production and the threat of glutathione depletion. However, the products of the GGT reaction may themselves lead to increased free radical production, particularly in the presence of iron. There have also been important advances in the definition of the associations between serum GGT and risk of coronary heart disease, Type 2 diabetes, and stroke. People with high serum GGT have higher mortality, partly because of the association between GGT and other risk factors and partly because GGT is an independent predictor of risk. This review aims to summarize the knowledge about GGT's clinical applications, to present information on its physiological roles, consider the results of epidemiological studies, and assess how far these separate areas can be combined into an integrated view.