Li Yifei, Zhang Peiting, Deng Yuqing, Yu Chao, Chen Xuechen, Liu Xinyu, Yang Qiaoqiao, Jiang Jingcheng, Chen Xu, Xue Hongliang
Department of Nutrition, School of Public Health, Guangzhou Medical University, Guangzhou, China.
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China.
J Nutr. 2025 Mar;155(3):975-984. doi: 10.1016/j.tjnut.2025.01.009. Epub 2025 Jan 10.
Previous observational studies have not reached an agreement on the association between coffee consumption and risk of liver diseases. Also, none of these studies took sweetener added in coffee into consideration.
We aim to explore the associations of consumption of sweetened and unsweetened coffee with chronic liver disease (CLD) and liver-related events (LREs), and evaluate the degree to which sweetener added counteracted the effect of coffee.
We performed a longitudinal cohort study of 170,044 participants without liver diseases or cancer at baseline investigation (2006-2010) and followed until 2022. Consumption of coffee and sweetener was assessed by 24-h dietary recall questionnaire. Cox proportional hazards models and restricted cubic splines were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
During a median follow-up of 12.4 y, we identified 4152 incident of CLD and 853 LREs. Compared with nonconsumers, unsweetened coffee consumers of various amount had lower risk of CLD (HR: 0.75; 95% CI: 0.67, 0.83 for 1.5∼2.5 drinks/d) and LREs (HR: 0.60; 95% CI: 0.46, 0.80 for 2.5∼3.5 drinks/d) in the multivariable Cox models. U-shaped associations of unsweetened coffee with CLD and LREs were observed. The results for sweetened coffee were less consistent and conclusive in both CLD and LREs. We detected positive associations between sweetener and CLD and LREs. Compared with unsweetened coffee consumers, consumers of different amount of sugar added to coffee had higher risk of CLD in the multivariable Cox model. For artificial sweetener, a significant higher risk of CLD (HR: 1.61; 95% CI: 1.25, 2.05)and LREs (HR: 1.82; 95% CI: 1.11, 2.98) was only found in those who added ≥2 teaspoons/drink. We detected significant interaction between artificial sweetener and coffee intake on the risk of CLD (HR for product term: 0.76; 95% CI: 0.60, 0.96; P = 0.018; relative excess risk due to interaction: -0.32; 95% CI: -0.58, -0.06).
Moderate consumption of unsweetened coffee was associated with lower risk of CLD and LREs. Adding sweetener into coffee could bring additional risk of liver diseases in coffee consumers.
既往观察性研究对于咖啡饮用与肝脏疾病风险之间的关联尚未达成一致。此外，这些研究均未考虑咖啡中添加的甜味剂。
我们旨在探讨饮用加糖咖啡和不加糖咖啡与慢性肝病（CLD）及肝脏相关事件（LREs）之间的关联，并评估添加的甜味剂抵消咖啡作用的程度。
我们对170,044名在基线调查（2006 - 2010年）时无肝脏疾病或癌症的参与者进行了一项纵向队列研究，随访至2022年。通过24小时饮食回忆问卷评估咖啡和甜味剂的摄入量。使用Cox比例风险模型和受限立方样条来估计风险比（HRs）和95%置信区间（CIs）。
在中位随访12.4年期间，我们确定了4152例CLD事件和853例LREs事件。与不喝咖啡者相比，在多变量Cox模型中，不同饮用量的不加糖咖啡饮用者发生CLD的风险较低（对于每天饮用1.5至2.5杯：HR：0.75；95%CI：0.67，0.83），发生LREs的风险也较低（对于每天饮用2.5至3.5杯：HR：0.60；95%CI：0.46，0.80）。观察到不加糖咖啡与CLD和LREs呈U形关联。加糖咖啡在CLD和LREs方面的结果不太一致且结论性不强。我们检测到甜味剂与CLD和LREs之间存在正相关。在多变量Cox模型中，与不加糖咖啡饮用者相比，在咖啡中添加不同量糖的饮用者发生CLD的风险更高。对于人工甜味剂，仅在那些每天添加≥2茶匙/杯咖啡的人群中发现CLD（HR：1.61；95%CI：1.25，2.05）和LREs（HR：1.82；95%CI：1.1, 2.98）的风险显著更高。我们检测到人工甜味剂与咖啡摄入量在CLD风险上存在显著交互作用（交互项的HR：0.76；95%CI：0.60，0.96；P = 0.018；交互作用导致的相对超额风险： - 0.32；95%CI： - 0.58， - 0.06）。
适量饮用不加糖咖啡与较低的CLD和LREs风险相关。在咖啡中添加甜味剂可能会给咖啡饮用者带来额外的肝脏疾病风险。
