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Coffee, caffeine and life expectancy Overview A large 2017 study with over 500,000 participants across 10 European countries found a significant association between higher coffee consumption (calculated as more than 3 cups per day with 1 cup equal to 237ml) and lower risk of all-cause mortality1. The strongest associations were identified with digestive disease and mortality, mainly due to a lower risk of dying from liver conditions in both men and women1. Previously, research suggested that coffee was not associated with an increase in mortality, but data was not available to suggest that coffee was associated with a reduced risk of all-cause mortality2,3. A significant amount of further research has since been undertaken to consider the effect of coffee and caffeine intake on overall mortality4-16. Overall, the data suggests that coffee and caffeine intakes are associated with a reduced risk of all-cause mortality4-16 and in some cases, research suggests that coffee and caffeine may be associated with reduced mortality from specific conditions such as cardiovascular disease (CVD) and cancers at certain sites4-16.The European Food Safety Authority (EFSA) in a review on the Safety of Caffeine concluded that moderate caffeine consumption, of around 400mg caffeine per day (the equivalent of up to 5 cups of coffee), can be enjoyed as part of a healthy balanced diet and an active lifestyle17. Pregnant and breastfeeding women are advised to limit their caffeine intake to 200mg per day17.BackgroundLife expectancy is an important demographic statistic that can be used to compare the health status of different population groups. It takes into account gender and age as well as factors including diet, genetics and disease risk, and can be used to compare data from different countries, regions, and cultural and socio-economic groups. Life expectancy can also be expressed as mortality, or the risk of death18,19.As well as considering all-cause mortality, data is also available that considers mortality from specific conditions such as CVD or cancer19. Researchers may consider the effect of one dietary or lifestyle component, such as coffee consumption, on mortality from cardiovascular disease, cancer, or all-cause mortality.Coffee, caffeine and life expectancyEarly research suggested that coffee consumption was not associated with an increase in mortality, however the authors suggested further investigation of the possibility of a modest reduced risk of all-cause and CVD mortality2,3. The further research available today counters early views that coffee may be a less desirable component of the diet4-16. More recent meta-analyses have suggested that coffee may be associated with a reduced total mortality risk4-16. A large 2017 study with over 500,000 participants across 10 European countries found a significant association between higher coffee consumption (calculated as more than 3 cups per day with 1 cup equal to 237ml) and lower risk of all-cause mortality1.A number of reviews and meta-analyses have been published that consider the associations between coffee consumption and overall mortality, as well as mortality from specific conditions such as cancers and heart disease.All-cause mortalityA number of reviews and studies have considered associations between coffee and caffeine consumption and all-cause mortality, suggesting overall that coffee consumption is associated with reduced mortality risk.Two 2013 reviews considered the effects of coffee on various aspects of health, concluding that coffee?consumption is associated with reduced mortality risk4,5. Additionally, two 2014 reviews suggested that there was no association between coffee intake and all-cause mortality6,7. One concluded that the association was similar in men and women, but varied by location with a stronger association observed in Europe and Japan when compared to the USA7.Two studies considered associations at specific intakes of coffee. A large prospective study of 90,317 US adults concluded that coffee drinkers had lower risk ratios for overall mortality, and the risk was reduced with increasing cups of coffee, up to 4-5 cups a day. Similar findings were observed for both decaffeinated and caffeinated coffee8. A further review suggested that the largest risk reduction for various health outcomes was observed at 3-4 cups of coffee per day9.A 2016 review of over 95,000 individuals suggested that, observationally, coffee intake is associated with a U-shaped lower risk of cardiovascular disease and all-cause?mortality10.Data from a 2017 study of over 500,000 participants found a significant association between a higher coffee consumption (calculated as more than 3 cups per day with 1 cup equal to 237ml) and a lower risk of all-cause mortality. The strongest associations were observed with digestive disease mortality, mainly due to the lower risk of dying from liver disease in both men and women1. A population based cohort study, using data from the National Health and Nutrition Examination Survey (NHANES), concluded that a moderate caffeine intake was associated with a decreased risk of all-cause mortality, regardless of the presence or absence of coffee consumption11.Research from the Multiethnic Cohort Study concluded that coffee consumption was associated with lower total mortality after adjustment for smoking and other potential confounders, with similar trends seen for both caffeinated and decaffeinated coffee intake. Significant inverse associations were observed in four ethnic groups: African-Americans, Japanese-Americans, Latinos, and Caucasians, however the association in Native-Hawaiians did not reach statistical significance12.A 2018 population study of over 120,000 adults considered the effect of?coffee consumption, tea consumption, and the substitution of?coffee?for tea on mortality risk13. A higher coffee?intake was significantly, non-linearly related to lower overall and cause-specific mortality in women. The authors suggested that for men, compared to exclusive coffee drinkers, those drinking 30-50% tea showed the lowest mortality risk, and any tea drinking resulted in a greater reduced risk than coffee drinking exclusively. For women, those who drank coffee exclusively,?or up to 40% tea had the lowest mortality, but those drinking higher percentages of tea were at increased mortality risk compared to exclusive?coffee?drinkers13.[potential graphic to be designed]Coffee intake and mortality risk>1 cup per dayLower all-cause mortality1,4-16Reduced risk of all-sites cancers with increasing intake of coffee and frequency of coffee consumption15>3 cups coffee per dayReduced risk of liver disease & circulatory disease1,93-5 cups per dayReduced risk of CVD, showing a ‘U-shaped’ association27,30,31 Reduced risk of all-sites cancers9,15,16, and notably liver cancer1.EFSA recommendation: around 400mg caffeine per day, equivalent to up to 5 cups of coffee can be enjoyed as part of healthy balanced diet17. Pregnant and breastfeeding women are advised to limit their caffeine intake to 200mg per day17.Coffee consumption and disease specific mortalityCardiovascular diseaseResearch into coffee consumption and CVD has suggested that a moderate intake of coffee may reduce CVD mortality risk20-37. Moderate coffee consumption can be defined as 3-5 cups per day, based on the European Food Safety Authority’s review of caffeine safety17.Specifically in relation to coronary heart disease, several studies suggest a protective effect at intakes of approximately 3-5 cups per day with the association resembling a U-shaped curve27,30,31. Studies reviewing associations between coffee consumption and stroke have suggested that a moderate intake is associated with a reduced risk of stroke, particularly in women32-37.Two 2013 reviews suggested that the effects of habitual?coffee?consumption are neutral and potentially beneficial when considering cardiovascular risks such as coronary heart disease, congestive heart failure, arrhythmias, and stroke4,5. The authors concluded that large epidemiological studies suggest that regular coffee drinkers have a reduced risk of?both cardiovascular and all cause mortality4,5. A further 2013 review concluded that habitual?coffee?consumption is associated with reduced?mortality, both for all-cause and cardiovascular deaths. The authors specifically noted that coffee?intake is associated with a reduced risk of heart failure, stroke, diabetes mellitus and some cancers, and showed neutral to reduced risks for both atrial and ventricular arrhythmias14. However,?they suggested that caffeine may increase anxiety, insomnia, calcium loss and possibly the risk of fractures in some, advising that adequate calcium intake was key for tea and coffee drinkers14. A 2018 population study suggested that in men,?coffee?was associated with an increased risk of cancer and cardiovascular mortality, and a reduced risk of respiratory and other causes of death13.CancerIn 2016, the International Agency for Research on Cancer (IARC) reviewed all available research on coffee and cancer, including research published since its original review in 1991, and found no clear association between coffee intake and cancer at any body site. In some cases, research suggested coffee drinking is associated with a reduced occurrence of certain cancers. IARC therefore classified coffee in Group 3, for agents “not classifiable as to carcinogenicity to humans”16. IARC classified beverages consumed at very high temperatures (defined as over 65°C) as “probably carcinogenic to the human oesophagus”16. However, 65°C is significantly hotter than the temperature at which most people can comfortably drink coffee without scalding their mouth and tongue38,39, coffee is typically drunk at temperatures below 60°C.A 2017 review of 39,685 men and 43,124 women suggested that increased frequency of coffee consumption was associated with a lower risk of cancer incidence in both men and women. Coffee consumption frequency was also associated with?reduced mortality?from cancer15.Contrarily, a 2018 population study suggested that in men,?coffee?was associated with an increased risk of cancer13.Potential mechanismsThe precise mechanisms to explain the suggested association between coffee consumption and reduced overall mortality risk are currently unknown, and research is ongoing to understand this area in more detail. However, a number of hypotheses exist and have considered roles for specific coffee constituents, including caffeine, cafestol and kahweol, as well as some of the phyto-chemicals found in coffee1,8,11,12.REFERENCESGunter M.J. et al. (2017) Coffee Drinking and Mortality in 10 European Countries, Ann Int Med, 167(4):236-247.Lopez-Garcia E. et al. (2008) The relationship of coffee consumption with mortality. Ann Intern Med, 148(12):904-14.Zhang W.L. et al. (2009) Coffee?consumption and risk of cardiovascular events and all-cause?mortality?among women with type 2 diabetes. Diabetologia, 52(5):810-7.O’Keefe J.H. et al. (2013) Effects of habitual?coffee?consumption on cardiometabolic disease, cardiovascular health, and all-cause?mortality. J Am Coll Cardiol, 62(12):1043-1051.Cano-Marquina A. et al. (2013) The impact of coffee on health. Maturitas, 75(1):7-21.Lopez-Garcia E. et al. (2014) Coffee consumption and health related quality of life. Clin Nutr, 33(1):143-9.Je Y., Giovannucci E. 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