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GI HEALTH AFFECTED BY CONSUMPTION OF COFFEE AND CARBONATED DRINKS
      06/04/04 06:30 PM
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GI HEALTH AFFECTED BY CONSUMPTION OF COFFEE AND CARBONATED DRINKS

Though Some Gain Liver Benefits from Coffee, Soda Drinkers at Increased Risk for Cancer

New Orleans, LA – According to new research presented today at Digestive Disease Week, drinking caffeinated beverages may benefit some people who are at high-risk for liver disease. Conversely, a study by researchers from India found that soda drinkers, who represent a huge percentage of the American population, may actually have an increased risk of developing esophageal cancer. DDW is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. "This research supports the widespread medical recommendations for healthy eating," said Lee Kaplan, M.D., Ph.D., of Massachusetts General Hospital. "The relationships between diet and disease that these investigators have seen are intriguing and should stimulate further exploration in this important area. It is even more apparent that lifestyle and dietary choices made during youth can have a significant impact on health later in life."

Coffee and Caffeine Consumption Protect Against Liver Injury in the United States Population (Abstract 100766*)

Researchers from the National Institute of Diabetes and Digestive and Kidney Disease of the National Institutes of Health are reporting that among people who are at high risk for liver problems, coffee drinking and consumption of other caffeinated beverages may reduce risk of liver disease. The national, population-based study was conducted among 5,944 adult participants of the third U.S. National Health and Nutrition Examination Survey (NHANES III) who were at high risk for liver injury (due to excessive alcohol consumption, hepatitis B or C, iron overload, obesity, or impaired

2 – 2 – 2 Coffee and Carbonated Drinks glucose metabolism). Participants were asked about consumption of caffeine-containing coffee, tea and soft drinks. The study found an inverse correlation between coffee and caffeine consumption and liver injury, which was classified by abnormal serum alanine aminotransferase (ALT) activity and was seen in approximately 8.7 percent of this high-risk population. In analyses both unadjusted and adjusted for age, sex, ethnicity and cigarette smoking, the prevalence of liver injury declined with increasing coffee drinking and caffeine consumption, though the protective effect was greater for caffeine intake. The correlation was consistent across subgroups when defined by individual risk factors for liver injury, as well as when applied to persons without impaired liver function.

"There is surprisingly little evidence-based information on the influence of diet and nutrition on the course and severity of chronic liver disease," said James Everhart, M.D., M.P.H., co- author of the study. "These results warrant further study."

Rise of Esophageal Adenocarcinoma in USA is Temporally Associated with the Rise in Carbonated Soft Drink Consumption (Abstract 105860*)

Researchers at Tata Memorial Hospital in India have found a strong correlation between the rise in per capita consumption of carbonated soft drinks (CSD) in the past 20 years and the increasing rates of esophageal cancer (ACE) in the United States. Based on available data on diet changes in America from the U.S. Department of Agriculture, per capita consumption of CSD rose by more than 450 percent during the past half-century, from 10.8 gallons in 1946 to 49.2 gallons in 2000. At the same time, in the last 25 years, incidence rates of ACE have risen by more than 570 percent in American white males and continue to increase.

The rise in CSD consumption preceded the rise in cases of ACE by 20 years. A 40 percent increase for each five-year increase in date of birth – a birth cohort effect – was previously reported. Using linear regression to compare trends between CSD and ACE rates, the researchers found a highly significant correlation between the two (r=0.99, 95% CI 0.96-1.0).

3 – 3 – 3 Coffee and Carbonated Drinks Researchers found published data for a strong biological basis to explain the increased dose and duration of esophageal exposure to acid: CSD drinking causes gastric distension that triggers reflux. Consumption of 350 milliliters of CSD per day (approximately one can of soda) corresponds to 53.5 minutes of pH less than four and 53 gallons per year translates to 32,100 more minutes of acid exposure per year. Excess CSD consumption started in childhood and American teenagers drank two cans of CSD per day on average, which can explain the birth cohort effect. White children drank significantly more CSD than black children. In general, identical time trends were seen worldwide, as countries with per capita CSD below 10 gallons (including Eastern Europe, Japan, China, Taiwan, Korea and India, among others) had little increase in the incidence of ACE.

Countries with per capita CSD of more than 20 gallons have seen a rising trend of ACE cases. "The surprisingly strong correlation demonstrates the impact of diet patterns on health trends," said Mohandas Mallath, M.D., lead author on the study. "This study re-emphasizes a general life style dictum that 'if little is good, a lot isn't better.' As the rates may continue to rise for another 20 years, we believe that more epidemiological studies are urgently required to establish the true association."

### Digestive Disease Week (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 15-20, 2004 in New Orleans, Louisiana. The meeting showcases approximately 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. *Abstract numbers listed above correlate to abstract ID numbers listed on the DDW Web site, www.ddw.org. They do not coincide with program numbers as found in the printed DDW Program Guide.

AbstractID – 100766 First Author – Ruhl Institution –

Social & Scientific Systems Coffee and Caffeine Consumption Protect Against Liver Injury in the United States

Population Constance E. Ruhl, James E. Everhart Background & Aims:

The concept that patient behavior may influence the course and severity of chronic liver disease is appealing, but not well investigated. Based on the results of experimental data and epidemiological surveys, we investigated whether coffee drinking and caffeine consumption reduced the risk of liver injury in persons at high risk for liver injury in a national, population-based study. Methods: 5,944 adult participants in the third U.S. National Health and Nutrition Examination Survey (NHANES III), 1988-1994, who were at high risk for liver injury (due to excessive alcohol consumption, hepatitis B or C, iron overload, obesity, or impaired glucose metabolism) were asked about consumption of caffeine-containing coffee, tea, and soft drinks. Total caffeine from these beverages was calculated and divided into quintiles. Liver injury was indicated by abnormal serum alanine aminotransferase (ALT) activity (> 43 U/L). All analyses incorporated sample weights and the design effects of the survey.

Results: Elevated ALT activity was found in 8.7% of this high risk population. In unadjusted analysis, the prevalence of liver injury declined with both increasing coffee drinking and caffeine consumption. (p<0.05). Multivariate logistic regression analyses adjusting for age, sex, ethnicity, and cigarette smoking, also demonstrated that the risk of liver injury declined with increasing coffee drinking and caffeine consumption, with the protective effect being stronger for caffeine consumption (table). These relationships were consistent across subgroups defined by individual risk factors for liver injury and relatively unchanged when analyses included all NHANES III participants or when limited to persons without impaired liver function and without right upper quadrant pain.

Conclusion: In this large, national, population-based study, among persons at high risk for liver injury, coffee drinking and caffeine consumption from beverages were associated with lower risk of injury. These possible beneficial effects deserve further investigation. Multivariate-adjusted Logistic Regression Odds Ratios and 95% Confidence Intervals for Elevated ALT OR 95% CI p-value for trend Coffee (cups / day) 0.034 0 1.0 < 1 1.4 0.84 - 2.4 1 - 2 0.83 0.49 - 1.4 > 2 0.56 0.31 - 1.0 Caffeine quintiles (mg / day) < 0.001 < 49 1.0 49 - < 142 0.78 0.49 - 1.3 142 - < 200 0.72 0.41 - 1.2 200 - < 373 0.62 0.35 - 1.1 >=373 0.31 0.16 - 0.61

AbstractID – 105860 First Author – Mallath Institution – Tata Memorial HospitalRise of Esophageal Adenocarcinoma in USA is Temporally Associated With the Rise in Carbonated Soft Drink Consumption. Mohandas K. Mallath

Background and Aims: Incidence rates for adenocarcinoma of the esophagus (ACE) in rose by 570% in American white males in last 25 years and is still continuing to rise. There has been a 40% increase for each 5-year increase in date of birth- a birth cohort effect (El-Serag HB et al. Gut 2002;50:368-372) The reason for this rise remains unexplained. Time-trends in rates of ACE have wide variations world wide. We aimed to identify potential new risk factors that could explain these observations.

Methods: US Department of Agriculture (USDA) data was searched for major changes in the diets of Americans in 5 decades. Per capita carbonated soft drinks (CSD) consumption rose by 450% in USA from 10.8 gallons in 1946 to 53 gallons in 2000. Rise in CSD consumption preceded the rise of ACE by 20 years. Temporal trends between 3-year average of per capita consumption of CSD and incidence of ACE were analyzed by linear regression.

Results: Highly significant correlation was obtained between 3-yearly incidence of ACE (1974-2000) and the 3-yearly per capita consumption of CSD 20 years before (1964-1980); r=0.99, 95%CI 0.92-1.0; p<0.001 r2=0.98. We found strong biological basis to explain increased dose and duration of exposure to acid: 1. Consumption of 350 ml CSD per day corresponds to 53.5 minutes of pH <4 (Shoenut et al. Dig Dis Sci 1998;43:834-39), and 53 gallons per year would mean 32100 more minutes of acid exposure per year. 2. Excess CSD drinking started in childhood and American teenagers drank 2 cans of CSD per day (USDA) explaining the Birth Cohort Effect. 3. Prevalence of H pylori infection in the population fell during the same period to increase endogenous acid secretion. In general identical time trends were seen worldwide. Countries with per capita CSD below 10 gallons (e.g. East Europe, Japan, China, Taiwan, Korea, India, etc) had little increase in the incidence of ACE. Countries with per capita CSD more than 20 gallons are reporting a rising trend of ACE. Scotland with high rates of ACE over England had a 1.8 times higher consumption of CSD.

Conclusion: The linear association between per capita consumption of CSD 20 years before and the incidence of ACE is very strong. A biological explanation exists for this association, which is seen worldwide. The rising rates may continue for another 20 years. These findings are strong enough to initiate good epidemiological studies to establish the true association between CSD consumption and rates of ACE.

James Edgar Everhart, M.D., M.P.H. James Everhart, M.D., M.P.H., currently serves as chief medical officer of the Epidemiology and Clinical Trials Division of Digestive Diseases and Nutrition at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). His major research interests include digestive diseases, nutrition and epidemiology. Dr. Everhart maintains professional memberships in the Society for Epidemiological Research, the American Gastroenterological Association and the American Association for the Study of Liver Disease. He received the National Institute of Health's Director's Award in 1995 and has co-authored more than 100 articles appearing in publications such as the American Journal of Public Health, Journal of the American Medical Association and Hepatology. Additionally, Dr. Everhart has been invited to more than 30 presentations for organizations including the National Cancer Institute and the National Institute of Health. Dr. Everhart earned his bachelors in chemistry from Duke University and his doctor of medicine from the University of Virginia School of Medicine. He earned his masters in public health from Johns Hopkins School of Hygiene and Public Health. Dr. Everhart completed his residency in internal medicine at Allentown Affiliated Hospitals.

Mohandas K. Mallath, M.D. Mohandas K. Mallath, M.D., is professor and head of the Department of Digestive Diseases and Clinical Nutrition and officer-in-charge of the Postgraduate Studies Section at Tata Memorial Hospital. His research interests include cancer chemotherapy, familial cancer, medical screening, pre-neoplastic lesions, clinical nutrition, epidemiology, clinical trials and medical ethics. Dr. Mallath maintains membership to the Tata Memorial Hospital Scientific Review Committee, the Ethics Committee and the Infection Control Committee. He is also member of international organizations such as the American College of Gastroenterology and the European Society for Enteral and Parenteral Nutrition. Dr. Mallath is president-elect of the Society for Gastrointestinal Endoscopy of India. He has had more than 80 peer reviewed articles, authored 20 book chapters and developed more than 90 conference abstracts. Dr. Mallath earned his bachelors degree from Goa Medical College and his medical degree from the University of Bombay. He completed his residency at Goa Medical College and his fellowship in gastroenterology and ICU at Tata Memorial Hospital.

http://www.ddw.org/media/newsReleases/Caffeine.pdf

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