Regular coffee: A magic bullet or a naked gun? Regular coffee but not espresso drinking is protective against fibrosis in NAFLD
Authors: Guglielmo M. Trovato, G. Fabio Martines, Francesca M. Trovato, Daniela Catalano
Journal: Journal of Hepatology (2013)

Regular coffee but not espresso drinking is protective against fibrosis in a cohort mainly composed of morbidly obese European women with NAFLD undergoing bariatric surgeryJournal of HepatologyVol. 57Issue 5PreviewThe aim of this study was to determine the influence of coffee and other caffeinated drinks on liver fibrosis of severely obese European patients. Full-Text PDF Reply to: “Regular coffee: A magic bullet or a naked gun? Regular coffee but not espresso drinking is protective against fibrosis in NAFLD”Journal of HepatologyVol. 58Issue 6PreviewWe have read with interest the comments and criticisms made by Trovato and colleagues concerning our recently published study [1]. We would like to clarify a number of specific points. Full-Text PDF Open Access We read with interest the article by Anty et al. [[1]Anty R. Marjoux S. Iannelli A. Patouraux S. Schneck A.S. Bonnafous S. et al.Regular coffee but not espresso drinking is protective against fibrosis in a cohort mainly composed of morbidly obese European women with NAFLD undergoing bariatric surgery.J Hepatol. 2012; 57: 1090-1096Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar] reporting that consumption of regular coffee but not of espresso is an independent protective factor for liver fibrosis, in severely obese European patients. Effects of coffee and caffeine on liver disease, including NAFLD, cirrhosis and HCC, have been reported over several years, with different methodological approaches and non-univocal results [2Costentin C.E. Roudot-Thoraval F. Zafrani E.S. Medkour F. Pawlotsky J.M. Mallat A. et al.Association of caffeine intake and histological features of chronic hepatitis C.J Hepatol. 2011; 54: 1123-1129Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar, 3La Vecchia C. Coffee, liver enzymes, cirrhosis and liver cancer.J Hepatol. 2005; 42: 444-446Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar, 4Catalano D. Martines G.F. Tonzuso A. Pirri C. Trovato F.M. Trovato G.M. Protective role of coffee in non-alcoholic fatty liver disease (NAFLD).Dig Dis Sci. 2010; 55: 3200-3206Crossref PubMed Scopus (81) Google Scholar]. We appreciate the great effort that the authors have put, working with an extremely selected population, and using very careful tools for the assessment of steatosis and fibrosis. Nonetheless, it appears useful to challenge the effective reliability of the methodology they have chosen for reaching their results and conclusion. The enthusiasm of the conclusion is perhaps not adequately supported by consistent data and is misleading for readers: “Consumption of regular filtrated coffee but not espresso was independently associated with a lower level of fibrosis in morbidly obese European patients. The finding that some compounds in coffee can protect from liver fibrosis is of potential pharmacological interest. As sugar could decrease the beneficial effect of coffee, coffee consumption, particularly regular coffee, could be encouraged but without sugar addition!” [[1]Anty R. Marjoux S. Iannelli A. Patouraux S. Schneck A.S. Bonnafous S. et al.Regular coffee but not espresso drinking is protective against fibrosis in a cohort mainly composed of morbidly obese European women with NAFLD undergoing bariatric surgery.J Hepatol. 2012; 57: 1090-1096Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar]. The authors [[1]Anty R. Marjoux S. Iannelli A. Patouraux S. Schneck A.S. Bonnafous S. et al.Regular coffee but not espresso drinking is protective against fibrosis in a cohort mainly composed of morbidly obese European women with NAFLD undergoing bariatric surgery.J Hepatol. 2012; 57: 1090-1096Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar] describe coffee both as a nutrient and as a blend of drugs, and also as different recipes. Why not as a high quality beverage? Looking at the statements of the conclusion, some details are not available: which espresso? Which pharmacological effect? From where does the sugar appear and is there any information on sugars in this study? Moreover, the predictive models used are not clearly described. Actually, it seems that only four of the six statistically different measures in the two groups are used (AST, caffeine from regular coffee, HOMA-IR and NASH) skipping ALT and quantity of regular coffee consumed (ml/wk). It is reasonable, in our view, that challenging and showing (if the current table refers to a stepwise regression) a more extended model could be possible and useful. In the data analysis, it is not clear if the overlap of use of different coffee beverages has any effect: the calculation of the overall content of caffeine appears very conjectural due to the obvious diversity of different coffee recipes. Essentially, 38 subjects (19.5%) drank only regular coffee, 76 (39%) only espresso: perhaps a plain comparison of these two “almost-pure” groups, as these are, could help. Information on regular coffee and caffeine intake relies entirely on self-reporting of the subjects and, much more important, depends on the quantity accounted for in this way. On this basis, the conclusion that different coffee recipes and preparations really have a homogenous content of caffeine is quite difficult to confirm or accept. Even the definition of “espresso” cup adopted by Anty et al. [[1]Anty R. Marjoux S. Iannelli A. Patouraux S. Schneck A.S. Bonnafous S. et al.Regular coffee but not espresso drinking is protective against fibrosis in a cohort mainly composed of morbidly obese European women with NAFLD undergoing bariatric surgery.J Hepatol. 2012; 57: 1090-1096Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar] is very far from what the word really represents [[5]Illy E. Navarini L. Neglected food bubbles: the espresso coffee foam.Food Biophys. 2011; 6: 335-348Crossref PubMed Scopus (54) Google Scholar]: the current quantity of a cup of espresso [[5]Illy E. Navarini L. Neglected food bubbles: the espresso coffee foam.Food Biophys. 2011; 6: 335-348Crossref PubMed Scopus (54) Google Scholar] is almost 10–15% of the quantity stated by the authors in the table available as Supplementary material of the article [[1]Anty R. Marjoux S. Iannelli A. Patouraux S. Schneck A.S. Bonnafous S. et al.Regular coffee but not espresso drinking is protective against fibrosis in a cohort mainly composed of morbidly obese European women with NAFLD undergoing bariatric surgery.J Hepatol. 2012; 57: 1090-1096Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar]. There is also a different perspective: it is possible, if not likely, that the nutritional behavior of obese people using regular coffee – any quantity – is different from the nutritional and lifestyle behavior (including physical exercise) of obese people drinking espresso coffee. Unfortunately, in this study, we do not have any information on the nutritional profile of this population and of the two main subgroups. No information is available on their physical exercise habits, socioeconomical status and other factors that could affect food intake and obesity. Last but not least, no definition of “malnutrition” and of related markers is considered: it should be considered and could be a useful issue in dealing with obesity, steatosis and fibrosis in liver disease. Overall, several major confounders are not sufficiently taken into account in this study, as it is currently presented: interpretations should have been more carefully reviewed by the authors and, particularly, some reappraisal of correlations introduced. The latter as presented and interpreted, may be confusing if not misleading. The article is still lacking reliable nutritional information in the prevention or treatment, if any, of fibrosis and NAFLD, and we need consistent evidence and less conjecture. The authors declare that they do not have anything to disclose regarding funding or conflict of interest with respect to this Letter.