Even high amounts of coffee may lower your risk for liver disease

By Kristen Rogers, CNN

(CNN) — Your daily cup of coffee may lower your risk for liver disease or liver cancer, a large new study has found — even if you drink five or more cups a day.

The findings are based on more than 354,000 participants whom researchers followed for more than a decade, according to the study published Wednesday in the journal Clinical Gastroenterology and Hepatology.

“This is probably the most comprehensive long-term follow-up data of the coffee’s impact,” said first study author Dr. Hyunseok Kim, a transplant hepatologist at Cedars-Sinai Medical Center in Los Angeles. “We do see that probably, the liver benefit from the coffee is not from the caffeine, because we do see the similar benefit in the decaffeinated drinkers. So it seems more related to the anti-oxidative effect of the coffee.”

In the study, the researchers measured liver disease by the number of cases of cirrhosis — permanent liver scarring and damage that can result from several long-term liver diseases, including fatty liver disease, viral hepatitis, alcohol-related liver disease and more, especially when untreated. Cirrhosis affects more than 58 million people worldwide, and it kills nearly 1.5 million people worldwide yearly.

Hepatocellular carcinoma, the type of liver cancer the authors measured, is the most common liver cancer, with nearly 685,000 cases and more than 597,000 deaths occurring globally every year.

The researchers found that the potential protective effect of coffee generally increased the more participants drank: One to two cups daily was associated with a 20% lower risk of cirrhosis, a 24% lower risk of liver cancer and 31% lower odds of liver-related death. Three to four cups daily was linked with a 35% lower risk of cirrhosis and of liver cancer, and a 41% lower chance of liver-related death. Five cups or more was correlated with a 32% lower risk of cirrhosis, a 47% decrease in risk for liver cancer and 42% lower odds for liver-related death.

“Those are meaningful numbers for something as ordinary as a daily cup of coffee,” said Lauren Manaker, a registered dietitian nutritionist who wasn’t involved in the study, via email. But “these are associations, not proof of cause.”

Consuming coffee safely

The researchers also found that these risk reductions among those who sweetened their coffee with sugar or substitutes were slightly lower but otherwise similar.

But you should still be smart about your intake of sugar, artificial sweeteners and highly processed creamers.

Participants who used sweeteners had an elevated marker for liver inflammation, which can contribute to fatty liver disease, said Kim, also an assistant professor in the Karsh Division of Gastroenterology and Hepatology at Cedars-Sinai Medical Center.

The American Heart Association recommends limiting added sugar intake to no more than 6% of daily calories — 9 teaspoons or 36 grams for men and 6 teaspoons or 26 grams for women. The US Food and Drug Administration recommends limiting caffeine intake to no more than 400 milligrams per day for generally healthy adults — which amounts to about two to three 12-ounce cups of coffee. But caffeine sensitivity and metabolism can widely vary.

To avoid caffeine interfering with your sleep, stop drinking it at least six hours before your normal bedtime — some experts say no caffeine after 3 p.m.

Other coffee questions need answers

In the new research, advanced MRI imaging and other analyses showed coffee drinkers also had healthier liver protein profiles and less liver fat and inflammation.

“Combining the three layers of evidence is the real strength,” said Manaker, owner of Nutrition Now Counseling, a nutrition communications business based in Charleston, South Carolina. “When the imaging and the proteins line up with the clinical outcomes, the overall picture becomes more believable than any one measure would be alone.”

The study does have a few important limitations. Coffee intake was measured only at the beginning and when the MRIs were conducted 10 or more years later, which is a lot of time for other influential factors to arise.

“We should treat that one early measurement as a rough guide to long-term habits rather than a precise record,” Manaker said.

Additionally, more than 90% of participants were European and relatively health-conscious, and only 10% of the entire group underwent MRIs, Kim said.

“There can be a little bit of bias to it,” he added. “Whether this benefit will be the same in the diverse ethnic group, like the US population, needs further validation.”

But the antioxidants in coffee, regardless of caffeine content, may decrease the activation of pathways or proteins that lead to inflammation and scarring, Kim said.

The liver isn’t the only thing coffee may be good for — many other studies have found it’s associated with a lower risk for type 2 diabetes, heart disease and failure, stroke, dementia and other chronic diseases.

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