The Corpus Callosum

Higher coffee consumption has been associated inversely with the incidence of chronic liver disease in population studies. We examined the relationship of coffee consumption with liver disease progression in individuals with advanced hepatitis C-related liver disease. Baseline coffee and tea intake were assessed in 766 participants of the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) trial who had hepatitis C-related bridging fibrosis or cirrhosis on liver biopsy and failed to achieve a sustained virological response to peginterferon plus ribavirin treatment. Participants were followed for 3.8 years for clinical outcomes and, for those without cirrhosis, a 2-point increase in Ishak fibrosis score on protocol biopsies. At baseline, higher coffee consumption was associated with less severe steatosis on biopsy, lower serum aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, alpha-fetoprotein, insulin, and homeostatic model assessment (HOMA2) score, and higher albumin (P < 0.05 for all). Two hundred thirty patients had outcomes. Outcome rates declined with increasing coffee intake: 11.1/100 person-years for none, 12.1 for less than 1 cup/day, 8.2 for 1 to fewer than 3 cups/day, and 6.3 for 3 or more cups/day (P-trend = 0.0011). Relative risks (95% confidence intervals) were 1.11 (0.76-1.61) for less than 1 cup/day; 0.70 (0.48-1.02) for 1 to fewer than 3 cups/day; and 0.47 (0.27-0.85) for 3 or more cups/day (P-trend = 0.0003) versus not drinking. Risk estimates did not vary by treatment assignment or cirrhosis status at baseline. Tea intake was not associated with outcomes. Conclusion: In a large prospective study of participants with advanced hepatitis C-related liver disease, regular coffee consumption was associated with lower rates of disease progression.

We see a lot of these studies that show THIS is correlated with THAT, with no convincing data regarding causality.  Then the chorus sings "Correlation is not causation, tra-la-la."  However, this is an unusually strong correlation, with an apparent dose-response relationship.  A 53% reduction in disease progression is a robust finding.  Consider this:

Treatment with peginterferon and ribavirin for 24-48 weeks clears virus and resolves chronic hepatitis in approximately half of patients.

So the best treatment we have, only works half the time.  Plus, a 10-day supply of ribavirin costs $260; a single 1ml vial (180mcg/ml) of peginterferon costs $606.  You can get some really good coffee for that kind of money.

Because of the nature of the study, I suspect that the only firm conclusion that you can draw is that coffee drinking is not harmful for persons with advanced hep C.  That is different than saying it actually is good.  Furthermore, it is important to notice that the study was done in persons with advanced hepatitis C who had failed to show adequate response to peginterferon plus ribavirin treatment.  That is a select population; it simply is not possible to generalize from this.

The point of the paper is that there are few options available for these patients, so any glimmer of hope is a good thing.  As the authors state:

[P]atients ineligible for or unable to tolerate treatment have few additional options, such that identification of modifiable risk factors for disease progression is a clinically important issue.

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Freedman, N., Everhart, J., Lindsay, K., Ghany, M., Curto, T., Shiffman, M., Lee, W., Lok, A., Di Bisceglie, A., Bonkovsky, H., Hoefs, J., Dienstag, J., Morishima, C., Abnet, C., Sinha, R., & , . (2009). Coffee intake is associated with lower rates of liver disease progression in chronic hepatitis C Hepatology, 50 (5), 1360-1369 DOI: 10.1002/hep.23162