Effects of caffeine on human health

Caffeine's implications for women's health and survey of obstetrician-gynecologists' caffeine knowledge and assessment practices

OBJECTIVE

Caffeine has relevance for women's health and pregnancy, including significant associations with spontaneous abortion and low birth weight. According to scientific data, pregnant women and women of reproductive age should be advised to limit their caffeine consumption. This article reviews the implications of caffeine for women's psychological and physical health, and presents data on obstetrician-gynecologists' (ob-gyns) knowledge and practices pertaining to caffeine.

METHODS

Ob-gyns (N = 386) who are members of the American College of Obstetricians and Gynecologists' Collaborative Ambulatory Research Network responded to a 21-item survey about caffeine.

RESULTS

Although most knew that caffeine is passed through breast milk, only 24.8% were aware that caffeine metabolism significantly slows as pregnancy progresses. Many respondents were not aware of the caffeine content of commonly used products, such as espresso and Diet Coke, with 14.3% and 57.8% indicating amounts within an accurate range, respectively. Furthermore, ob-gyns did not take into account large differences in caffeine content across different caffeinated beverages with most recommending one to two servings of coffee or tea or soft drinks per day. There was substantial inconsistency in what was considered to be "high levels" of maternal caffeine consumption, with only 31.6% providing a response. When asked to indicate the risk that high levels of caffeine have on various pregnancy outcomes, responses were not consistent with scientific data. For example, respondents overestimated the relative risk of stillbirths and underestimated the relative risk of spontaneous abortion. There was great variability in assessment and advice practices pertaining to caffeine. More than half advise their pregnant patients to consume caffeine under certain circumstances, most commonly to alleviate headache and caffeine withdrawal.

CONCLUSIONS

The data suggest that ob-gyns could benefit from information about caffeine and its relevance to their clinical practice. The development of clinical practice guidelines for caffeine may prove to be useful.

Consumption of caffeinated coffee and a high carbohydrate meal affects postprandial metabolism of a subsequent oral glucose tolerance test in young, healthy males

Caffeine and caffeinated coffee (CC) elicit acute insulin insensitivity when ingested before a carbohydrate load. The effects of CC on glucose tolerance and insulin sensitivity when co-ingested with a high carbohydrate meal and on postprandial metabolism of a subsequent (second) carbohydrate load have not been studied. In a randomised, crossover design, ten healthy males ingested either CC (5 mg caffeine/kg body weight), decaffeinated coffee (DC) or water (W; equal volume) co-ingested with a high glycaemic index cereal followed 3 h later by a 75 g oral glucose tolerance test. After the initial meal, insulin area under the curve (AUC) and insulin sensitivity index did not differ between treatments, although glucose AUC for CC (107 (sem 18) mmol/l × 3 h) and DC (74 (sem 15) mmol/l × 3 h) was greater than W ( − 0·2 (sem 29) mmol/l × 3 h, P < 0·05). After the second carbohydrate load, insulin AUC for CC was 49 % and 57 % greater (P < 0·01) than for DC and W, respectively. Despite the greater insulin response, glucose AUC for CC (217 (sem 24) mmol/l × 2 h) was greater than both DC (126 (sem 11) mmol/l × 2 h, P = 0·01) and W (55 (sem 34) mmol/l × 2 h, P < 0·001). Insulin sensitivity index after the second meal was lower after CC (8·2 (sem 0·9)) compared with both DC (12·4 (sem 1·2), P < 0·01) and W (13·4 (sem 1·4), P < 0·001). Co-ingestion of CC with one meal resulted in insulin insensitivity during the postprandial phase of a second meal in the absence of further CC ingestion. Thus, CC may play a role in daily glycaemic management.

The effect of daily caffeine use on cerebral blood flow: How much caffeine can we tolerate?

Caffeine is a commonly used neurostimulant that also produces cerebral vasoconstriction by antagonizing adenosine receptors. Chronic caffeine use results in an adaptation of the vascular adenosine receptor system presumably to compensate for the vasoconstrictive effects of caffeine. We investigated the effects of caffeine on cerebral blood flow (CBF) in increasing levels of chronic caffeine use. Low (mean = 45 mg/day), moderate (mean = 405 mg/day), and high (mean = 950 mg/day) caffeine users underwent quantitative perfusion magnetic resonance imaging on four separate occasions: twice in a caffeine abstinent state (abstained state) and twice in a caffeinated state following their normal caffeine use (native state). In each state, there were two drug conditions: participants received either caffeine (250 mg) or placebo. Gray matter CBF was tested with repeated-measures analysis of variance using caffeine use as a between-subjects factor, and correlational analyses were conducted between CBF and caffeine use. Caffeine reduced CBF by an average of 27% across both caffeine states. In the abstained placebo condition, moderate and high users had similarly greater CBF than low users; but in the native placebo condition, the high users had a trend towards less CBF than the low and moderate users. Our results suggest a limited ability of the cerebrovascular adenosine system to compensate for high amounts of daily caffeine use.

Does long-term coffee intake reduce type 2 diabetes mellitus risk?

This review reports the evidence for a relation between long-term coffee intake and risk of type 2 diabetes mellitus. Numerous epidemiological studies have evaluated this association and, at this moment, at least fourteen out of eighteen cohort studies revealed a substantially lower risk of type 2 diabetes mellitus with frequent coffee intake. Moderate coffee intake (>/=4 cups of coffee/d of 150 mL or >/=400 mg of caffeine/d) has generally been associated with a decrease in the risk of type 2 diabetes mellitus. Besides, results of most studies suggest a dose-response relation, with greater reductions in type 2 diabetes mellitus risk with higher levels of coffee consumption. Several mechanisms underlying this protective effect, as well as the coffee components responsible for this association are suggested. Despite positive findings, it is still premature to recommend an increase in coffee consumption as a public health strategy to prevent type 2 diabetes mellitus. More population-based surveys are necessary to clarify the long-term effects of decaffeinated and caffeinated coffee intake on the risk of type 2 diabetes mellitus.

Sensory characteristics and consumer acceptability of decaffeinated green teas

Green tea has been widely consumed for its mild flavors and its health benefits, yet caffeine in green tea has been a limitation for those who want to avoid it. The limitation brought increase in need for decaffeinated products in the green tea market. Most of the conventional decaffeination techniques applied in food use organic solvents. However, supercritical carbon dioxide fluid extraction (SC-CO2) method is gaining its intension as one of the future decaffeination methods that overcomes the problems of conventional methods. The purpose of this study was to identify sensory characteristics of decaffeinated green teas applied with SC-CO2 method and to observe the relationship with consumer acceptability to elucidate the potentiality of applying SC-CO2 technique in decaffeinated green tea market. Descriptive analysis was performed on 8 samples: green teas containing 4 caffeine levels (10%, 35%, 60%, and 100%) infused at 2 infusing periods (1 or 2 min). It was found that the SC-CO2 process not only reduced caffeine but also decreased some important features of original tea flavors. Two groups were recruited for consumer acceptability test: one (GP I, N = 52), consuming all types of green teas including hot/cold canned teas; and the other (GP II, N = 40), only consuming the loose type. While GP II liked original green tea the most, GP I liked highly decaffeinated green teas. Although the SC-CO2 method had limitations of losing complex flavors of green teas, it appeared to have future potential in the decaffeinated green tea market within or without the addition of desirable flavors.

Choice of environmental components for a longitudinal birth cohort study

Various aspects of the environment of the mother and child may have major influences on the health and development of the child. Long-term influences can even affect chronic diseases of adulthood. Here we describe the major psychosocial and physical environmental factors that should be measured in longitudinal birth cohort studies.

A genetic analysis of coffee consumption in a sample of Dutch twins

Caffeine is by far the most commonly used psychoactive substance. Caffeine is consumed regularly as an ingredient of coffee. Coffee consumption and coffee preference was explored in a sample of 4,495 twins (including 1,231 pairs) registered with the Netherlands Twin Registry. Twin resemblance was assessed by tetrachoric correlations and the influence of both genetic and environmental factors was explored with model fitting analysis in MX. Results showed moderate genetic influences (39%) on coffee consumption. The remaining variance was explained by shared environmental factors (21%) and unique environmental factors (40%). The variance in coffee preference (defined as the proportion of coffee consumption relative to the consumption of coffee and tea in total) was explained by genetic factors (62%) and unique environmental factors (38%).

Caffeine use in children: what we know, what we have left to learn, and why we should worry

Caffeine is a widely used psychoactive substance in both adults and children that is legal, easy to obtain, and socially acceptable to consume. Although once relatively restricted to use among adults, caffeine-containing drinks are now consumed regularly by children. In addition, some caffeine-containing beverages are specifically marketed to children as young as 4 years of age. Unfortunately, our knowledge of the effects of caffeine use on behavior and physiology of children remains understudied and poorly understood. The purpose of this article is to review what is known about caffeine use in children and adolescents, to discuss why children and adolescents may be particularly vulnerable to the negative effects of caffeine, and to propose how caffeine consumption within this population may potentiate the rewarding properties of other substances. The following topics are reviewed: (1) tolerance and addiction to caffeine, (2) sensitization and cross-sensitization to the effects of caffeine, (3) caffeine self-administration and reinforcing value, and (4) conditioning of preferences for caffeine-containing beverages in both adults and children.

Methodological considerations for the quantification of self-reported caffeine use

RATIONALE

The field of research regarding the effects of habitual caffeine use is immense and frequently utilizes self-report measures of caffeine use. However, various self-report measures have different methodologies, and the accuracy of these different methods has not been compared.

MATERIALS AND METHODS

Self-reported caffeine use was estimated from two methods (a retrospective interview of weekly caffeine use and a 7-day prospective diary; n = 79). These estimates were then tested against salivary caffeine concentrations in a subset of participants (n = 55).

RESULTS

The estimates of caffeine use (mg/day) from the interview- and diary-based methods correlated with one another (r = 0.77) and with salivary caffeine concentrations (r = 0.61 and 0.68, respectively). However, almost half of the subjects who reported more than 600 mg/day in the interview reported significantly less caffeine use in the diary.

CONCLUSIONS

Self-report measures of caffeine use are a valid method of predicting actual caffeine levels. Estimates of high caffeine use levels may need to be corroborated by more than one method.

Caffeine and sports performance

Athletes are among the groups of people who are interested in the effects of caffeine on endurance and exercise capacity. Although many studies have investigated the effect of caffeine ingestion on exercise, not all are suited to draw conclusions regarding caffeine and sports performance. Characteristics of studies that can better explore the issues of athletes include the use of well-trained subjects, conditions that reflect actual practices in sport, and exercise protocols that simulate real-life events. There is a scarcity of field-based studies and investigations involving elite performers. Researchers are encouraged to use statistical analyses that consider the magnitude of changes, and to establish whether these are meaningful to the outcome of sport. The available literature that follows such guidelines suggests that performance benefits can be seen with moderate amounts (~3 mg.kg-1 body mass) of caffeine. Furthermore, these benefits are likely to occur across a range of sports, including endurance events, stop-and-go events (e.g., team and racquet sports), and sports involving sustained high-intensity activity lasting from 1-60 min (e.g., swimming, rowing, and middle and distance running races). The direct effects on single events involving strength and power, such as lifts, throws, and sprints, are unclear. Further studies are needed to better elucidate the range of protocols (timing and amount of doses) that produce benefits and the range of sports to which these may apply. Individual responses, the politics of sport, and the effects of caffeine on other goals, such as sleep, hydration, and refuelling, also need to be considered.

Caffeine-induced psychosis

As a competitive adenosine antagonist, caffeine affects dopamine transmission and has been reported to worsen psychosis in people with schizophrenia and to cause psychosis in otherwise healthy people. We report of case of apparent chronic caffeine-induced psychosis characterized by delusions and paranoia in a 47-year-old man with high caffeine intake. The psychosis resolved within 7 weeks after lowering caffeine intake without use of antipsychotic medication. Clinicians might consider the possibility of caffeinism when evaluating chronic psychosis.

Caffeine in pregnancy

Caffeine is probably the most frequently ingested pharmacologically active substance in the world. It is found in common beverages (coffee, tea, soft drinks), in products containing cocoa or chocolate, and in medications. Because of its wide consumption at different levels by most segments of the population, the public and the scientific community have expressed interest in the potential for caffeine to produce adverse effects on human health. Reproductive-aged and pregnant women are 'at risk' subgroups of the population who may require specific advice on moderating their daily caffeine intake. This article highlights the implications of caffeine intake in pregnancy, reviews the latest evidence-based information available on this subject, and offers recommendations (practical advice) for the obstetrician-gynecologists proving peripartum care to these potentially complicated pregnancies.

Macroautophagy: the key ingredient to a healthy diet?

Dietary compounds can influence the risk of cancer and other diseases through diverse mechanisms which include the activation or inhibition of macroautophagy. Macroautophagy is a catabolic process for the lysosomal degradation and recycling of cytoplasmic constituents which has been implicated in several pathologies, including cancer and neurodegeneration. In some instances, macroautophagy acts to suppress tumor formation and neural degeneration. Thus, it may be feasible to design diets, supplements or therapeutics that can alter the level of macroautophagy within cells to prevent or treat disease. While critical questions still need to be answered before we can safely and effectively implement such a strategy, we provide here a review of the literature regarding dietary constituents that have a demonstrated macroautophagy-modulating function.

Daily consumption of an aqueous green tea extract supplement does not impair liver function or alter cardiovascular disease risk biomarkers in healthy men

Regular consumption of green tea polyphenols (GTP) is thought to reduce the risk of cardiovascular disease (CVD) but has also been associated with liver toxicity. The present trial aimed to assess the safety and potential CVD health beneficial effects of daily GTP consumption. We conducted a placebo-controlled parallel study to evaluate the chronic effects of GTP on liver function and CVD risk biomarkers in healthy men. Volunteers (treatment: n = 17, BMI 26.7 +/- 3.3 kg/m(2), age 41 +/- 9 y; placebo, n = 16, BMI 25.4 +/- 3.3 kg/m(2), age 40 +/- 10 y) consumed for 3 wk 6 capsules per day (2 before each principal meal) containing green tea extracts (equivalent to 714 mg/d GTP) or placebo. At the beginning and end of the intervention period, we collected blood samples from fasting subjects and measured vascular tone using Laser Doppler Iontophoresis. Biomarkers of liver function and CVD risk (including blood pressure, plasma lipids, and asymmetric dimethylarginine) were unaffected by GTP consumption. After treatment, the ratio of total:HDL cholesterol was significantly reduced in participants taking GTP capsules compared with baseline. Endothelial-dependent and -independent vascular reactivity did not significantly differ between treatments. In conclusion, the present data suggests that the daily consumption of high doses of GTP by healthy men for 3 wk is safe but without effects on CVD risk biomarkers other than the total:HDL cholesterol ratio.

Caffeine consumption and the risk of breast cancer in a large prospective cohort of women

BACKGROUND

Prospective data relating caffeine consumption to breast cancer risk are limited.

METHODS

We evaluated the association between caffeine consumption and breast cancer risk in women enrolled in a completed cancer prevention trial. Detailed dietary information was obtained at baseline (1992-1995) from 38 432 women 45 years or older and free of cancer. During a mean follow-up of 10 years, we identified 1188 invasive breast cancer cases.

RESULTS

Consumption of caffeine and caffeinated beverages and foods was not statistically significantly associated with overall risk of breast cancer. The multivariate relative risks (RRs) of breast cancer were 1.02 (95% confidence interval [CI], 0.84-1.22) for caffeine (top vs bottom quintile), 1.08 (0.89-1.30) for coffee (> or =4 cups daily vs almost never), and 1.03 (0.85-1.25) for tea (> or =2 cups daily vs almost never). However, in women with benign breast disease, a borderline significant positive association with breast cancer risk was observed for the highest quintile of caffeine consumption (RR, 1.32; 95% CI, 0.99-1.76) and for the highest category of coffee consumption (> or =4 cups daily) (1.35; 1.01-1.80); tests for interaction were marginally significant. Caffeine consumption was also significantly positively associated with risk of estrogen receptor-negative and progesterone receptor-negative breast cancer (RR, 1.68; 95% CI, 1.01-2.81) and breast tumors larger than 2 cm (1.79; 1.18-2.72).

CONCLUSIONS

These data show no overall association between caffeine consumption and breast cancer risk. The possibility of increased risk in women with benign breast disease or for tumors that are estrogen and progesterone receptor negative or larger than 2 cm warrants further study.

Review of the dietary reference intake for calcium: where do we go from here?

In this article the science relied on to establish the Dietary Reference Intakes (DRI) specifically for calcium was examined. The latest dietary recommendations for the essential nutrients significant with respect to their roles in bone metabolism and health were reported in the Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1997) (NIM, 1997). For calcium an adequate intake was recommended because insufficient data were available at the time to determine specific Recommended Dietary Allowances. Dietary intake data and the controversies regarding the role calcium may play in other chronic diseases have also been discussed. Advances and continued dilemmas regarding these topics reported since the publication of the DRI were also addressed in this review. A recent Dietary Reference Intake Research Synthesis Workshop report identified an extensive range of suggested future research directions needed to improve our understanding of calcium and bone and health.

Chemoprevention of dibenzo[a,l]pyrene transplacental carcinogenesis in mice born to mothers administered green tea: primary role of caffeine

Our laboratory recently developed a mouse model of transplacental induction of lymphoma, lung and liver cancer by the polycyclic aromatic hydrocarbon, dibenzo[a,l]pyrene (DBP). Pregnant B6129SF1 females, bred to 129S1/SvIm males, were treated on day 17 of gestation with an oral dose of 15 mg/kg DBP. Beginning on day 0 of gestation, dams were given (ad lib) buffered water, 0.5% green tea, 0.5% decaffeinated green tea, caffeine or epigallocatechin-3-gallate (EGCG) (both at equivalent concentrations found in tea). The concentration of the teas (and corresponding caffeine and EGCG) was increased to 1.0% upon entering the second trimester, 1.5% at onset of the third trimester and continued at 1.5% until pups were weaned at 21 days of age. Offspring were raised with normal drinking water and AIN93G diet. Beginning at 2 months of age, offspring experienced significant mortalities due to an aggressive T-cell lymphoma as seen in our previous studies. Ingestion of caffeinated, but not decaffeinated, green tea provided modest but significant protection (P = 0.03) against mortality. Caffeine provided a more robust (P = 0.006) protection, but EGCG was without effect. Offspring also developed DBP-dependent lung adenomas. All treatments significantly reduced lung tumor multiplicity relative to controls (P < 0.02). EGCG was most effective at decreasing tumor burden (P = 0.005) by on average over 40% compared with controls. Induction of Cytochrome P450 (Cyp)1b1 in maternal liver may reduce bioavailability of DBP to the fetus as a mechanism of chemoprevention. This is the first demonstration that maternal ingestion of green tea, during pregnancy and nursing, provides protection against transplacental carcinogenesis.

Protective effect of green tea polyphenols on bone loss in middle-aged female rats

Recent studies have suggested that green tea polyphenols (GTP) are promising agents for preventing bone loss in women. Findings that GTP supplementation resulted in increased urinary GTP concentrations and bone mass via an increase of antioxidant capacity and/or a decrease of oxidative stress damage suggest a significant role of GTP in bone health of women.

INTRODUCTION

Recent studies suggested that green tea polyphenols (GTP) are promising agents for preventing bone loss in women. However, the mechanism related to the possible protective role of GTP in bone loss is not well understood.

METHODS

This study evaluated bioavailability, mechanisms, bone mass, and safety of GTP in preventing bone loss in middle-aged rats without (sham, SH) and with ovariectomy (OVX). A 16-week study of 2 (SH vs. OVX) x 3 (no GTP, 0.1% GTP, and 0.5% GTP in drinking water) factorial design using 14-month-old female rats (n = 10/group) was performed. An additional 10 rats in baseline group were euthanized at the beginning of study to provide baseline parameters.

RESULTS

There was no difference in femur bone mineral density between baseline and the SH+0.5% GTP group. Ovariectomy resulted in lower values for liver glutathione peroxidase activity, serum estradiol, and bone mineral density. GTP supplementation resulted in increased urinary epigallocatechin and epicatechin concentrations, liver glutathione peroxidase activity and femur bone mineral density, decreased urinary 8-hydroxy-2'-deoxyguanosine and urinary calcium levels, but no effect on serum estradiol and blood chemistry levels.

CONCLUSION

We conclude that a bone-protective role of GTP may contribute to an increase of antioxidant capacity and/or a decrease of oxidative stress damage.

Comparing the benefits of caffeine, naps and placebo on verbal, motor and perceptual memory

Caffeine, the world's most common psychoactive substance, is used by approximately 90% of North Americans everyday. Little is known, however, about its benefits for memory. Napping has been shown to increase alertness and promote learning on some memory tasks. We directly compared caffeine (200mg) with napping (60-90min) and placebo on three distinct memory processes: declarative verbal memory, procedural motor skills, and perceptual learning. In the verbal task, recall and recognition for unassociated words were tested after a 7h retention period (with a between-session nap or drug intervention). A second, different, word list was administered post-intervention and memory was tested after a 20min retention period. The non-declarative tasks (finger tapping task (FTT) and texture discrimination task (TDT)) were trained before the intervention and then retested afterwards. Naps enhanced recall of words after a 7h and 20min retention interval relative to both caffeine and placebo. Caffeine significantly impaired motor learning compared to placebo and naps. Napping produced robust perceptual learning compared with placebo; however, naps and caffeine were not significantly different. These findings provide evidence of the limited benefits of caffeine for memory improvement compared with napping. We hypothesize that impairment from caffeine may be restricted to tasks that contain explicit information; whereas strictly implicit learning is less compromised.

Caffeinated coffee consumption impairs blood glucose homeostasis in response to high and low glycemic index meals in healthy men

BACKGROUND

The ingestion of caffeine (5 mg/kg body weight) and a 75-g oral glucose load has been shown to elicit an acute insulin-insensitive environment in healthy and obese individuals and in those with type 2 diabetes.

OBJECTIVE

In this study we investigated whether a similar impairment in blood glucose management exists when coffee and foods typical of a Western diet were used in a similar protocol.

DESIGN

Ten healthy men underwent 4 trials in a randomized order. They ingested caffeinated (5 mg/kg) coffee (CC) or the same volume of decaffeinated coffee (DC) followed 1 h later by either a high or low glycemic index (GI) cereal (providing 75 g of carbohydrate) mixed meal tolerance test.

RESULTS

CC with the high GI meal resulted in 147%, 29%, and 40% greater areas under the curve for glucose (P < 0.001), insulin (NS), and C-peptide (P < 0.001), respectively, compared with the values for DC. Similarly, with the low GI treatment, CC elicited 216%, 44%, and 36% greater areas under the curve for glucose (P < 0.001), insulin (P < 0.01), and C-peptide (P < 0.01), respectively. Insulin sensitivity was significantly reduced (40%) with the high GI treatment after CC was ingested compared with DC; with the low GI treatment, CC ingestion resulted in a 29% decrease in insulin sensitivity, although this difference was not significant.

CONCLUSION

The ingestion of CC with either a high or low GI meal significantly impairs acute blood glucose management and insulin sensitivity compared with ingestion of DC. Future investigations are warranted to determine whether CC is a risk factor for insulin resistance.

Tea or coffee? A case study on evidence for dietary advice

The present paper explores the level of evidence required to justify giving dietary advice to the public. There are important practical differences between the development of public health nutrition guidelines and guidelines for clinical practice. While the gold standard for evidence for clinical practice guidelines is a meta-analysis of a number of randomised controlled trials, this is often unrealistic and sometimes unethical for the evaluation of public health nutrition interventions. Hence, epidemiological studies make up the bulk of evidence for nutrition guidelines. Tea and coffee are an interesting case study in relation to this issue. They are two of the most commonly consumed beverages worldwide, yet there is little dietary advice on their use. The evidence for a relationship between coffee or tea consumption and several diseases is discussed. The available studies, predominantly epidemiological, together with animal and in vitro studies, indicate that coffee and tea are both safe beverages. However, tea is the healthier option because it has a possible role in the prevention of several cancers and CVD. While the evidence for such relationships is not strong, the public will continue to drink both tea and coffee, and will continue to ask nutritionists to make recommendations. It is therefore argued that advice should be given on the best available data, as waiting for complete data to become available could have severe consequences for public health.

Chemical composition of green tea (Camellia sinensis) infusions commercialized in Portugal

To evaluate the potential benefits and risks associated with tea consumption it is important to identify the constituents of this beverage. Levels of some minerals, caffeine and catechins in green tea samples commercialized in Portugal were evaluated. Potassium is the metal present in larger amount (92-151 mg/l). The content of sodium, calcium, fluoride, aluminium, manganese and iron were 35-69, 1.9-3.5, 0.80-2.0, 1.0-2.2, 0.52-1.9, 0.020-0.128 mg/l, respectively. Chromium and selenium were not detected. The resulting data showed considerable variability in catechins content. The levels of epigallocatechin gallate (EGCG) ranged from 117 to 442 mg/l, epicatechin 3-gallate (EGC) from 203 to 471 mg/l, epigallocatechin (ECG) from 16.9 to 150 mg/l, epicatechin (EC) from 25 to 81 mg/l and catechin (C) from 9.03 to 115 mg/l. Caffeine contents in the green tea infusions studied were between 141-338 mg/l. Green tea infusions provide significant amounts of catechins and could be an important source of some minerals.

Coffee, caffeine, and coronary heart disease

PURPOSE OF REVIEW

This review summarizes and highlights recent advances in current knowledge of the relationship between coffee and caffeine consumption and risk of coronary heart disease. Potential mechanisms and genetic modifiers of this relationship are also discussed.

RECENT FINDINGS

Studies examining the association between coffee consumption and coronary heart disease have been inconclusive. Coffee is a complex mixture of compounds that may have either beneficial or harmful effects on the cardiovascular system. Randomized controlled trials have confirmed the cholesterol-raising effect of diterpenes present in boiled coffee, which may contribute to the risk of coronary heart disease associated with unfiltered coffee consumption. A recent study examining the relationship between coffee and risk of myocardial infarction incorporated a genetic polymorphism associated with a slower rate of caffeine metabolism and provides strong evidence that caffeine also affects risk of coronary heart disease. Several studies have reported a protective effect of moderate coffee consumption, which suggests that coffee contains other compounds that may be beneficial.

SUMMARY

Diterpenes present in unfiltered coffee and caffeine each appear to increase risk of coronary heart disease. A lower risk of coronary heart disease among moderate coffee drinkers might be due to antioxidants found in coffee.

Shifts in patterns and consumption of beverages between 1965 and 2002

BACKGROUND

Beverage patterning may play a role in partially explaining the rising rates of obesity in the United States, yet little work on overall trends and patterns exits. Our objective was to examine trends and patterns of beverage consumption among U.S. adults.

METHODS

We used data from the nationally representative Nationwide Food Consumption Surveys (1965, 1977 to 1978) and the National Health and Nutrition Surveys (1988 to 1994, 1999 to 2002). To examine trends we determined percent consuming and per capita and per consumer caloric intake from all beverages. We used cluster analysis to determine year-specific beverage patterns in 1977 and 2002.

RESULTS

The percentage of calories from beverages significantly increased between 1965 (11.8%), 1977 (14.2%), 1988 (18.5%), and 2002 (21.0%); this represents an overall increase of 222 calories per person per day from beverages, resulting largely from increased intake of calorically sweetened beverages. Beverage patterns in 2002 were more complex than in 1977 and were dominated by a greater number of beverages, reflecting the increase in alcohol, soda, and diet beverages.

CONCLUSION

Calories from beverages increased substantially from 1965 to 2002, providing a considerable source of daily calories. Given the upward trends in calorically sweetened, nutrient-deficient beverages and the shifts in overall beverage patterns, addressing beverage intake is a salient issue for adults.

Long-term, moderate coffee consumption is associated with lower prevalence of diabetes mellitus among elderly non-tea drinkers from the Mediterranean Islands (MEDIS Study)

BACKGROUND

We evaluated the association between coffee drinking and the prevalence of type 2 diabetes mellitus in elderly people from the Mediterranean islands.

METHODS

During 2005-2007, 500 men and 437 women (aged 65 to 100 years) from the islands of Cyprus (n = 300), Mitilini (n = 142), Samothraki (n = 100), Cephalonia (n = 104), Corfu (n = 160) and Crete (n = 131) participated in the survey. Cardiovascular disease (CVD) risk factors (i.e. hypertension, diabetes, hypercholesterolemia and obesity), as well as behavioral, lifestyle and dietary characteristics were assessed using face-to-face interviews and standard procedures. Among various factors, fasting blood glucose was measured and prevalence of type 2 diabetes mellitus was estimated, according to the established American Diabetes Association (ADA) criteria, while all participants were asked about the frequency of any type of coffee consumption over the last year.

RESULTS

Coffee drinking was reported by 84% of the participants, the majority of whom drank boiled coffee. The participants reported that they had consumed coffee for at least 30 years of their life. Data analysis adjusted for various potential confounders, revealed that, compared to non-consumption, the multi-adjusted odds ratio for having diabetes was 0.47 (95%, CI 0.32 to 0.69) for 1-2 cups/day, while it was 1.05 (95%, CI 0.70 to 1.55) for >3 cups/day, after adjusting for various potential confounders. The association of coffee drinking with diabetes was significant only among non-tea drinkers. Increased coffee intake was not associated with diabetes prevalence.

CONCLUSION

The data presented suggest that moderate coffee drinking is associated with a lower likelihood of having diabetes, after adjusting for various potential confounders.

Maternal caffeine consumption and risk of cardiovascular malformations

BACKGROUND

The physiologic effects and common use of caffeine during pregnancy call for examination of maternal caffeine consumption and risk of birth defects. Epidemiologic studies have yielded mixed results, but such studies have grouped etiologically different defects and have not evaluated effect modification.

METHODS

The large sample size and precise case classification of the National Birth Defects Prevention Study allowed us to examine caffeine consumption and specific cardiovascular malformation (CVM) case groups. We studied consumption of caffeinated coffee, tea, soda, and chocolate to estimate total caffeine intake and separately examined exposure to each caffeinated beverage. Smoking, alcohol, vasoactive medications, folic acid supplement use, and infant gender were evaluated for effect modification. Maternal interview reports for 4,196 CVM case infants overall and 3,957 control infants were analyzed.

RESULTS

We did not identify any significant positive associations between maternal caffeine consumption and CVMs. For tetralogy of Fallot, nonsignificant elevations in risk were observed for moderate (but not high) caffeine intake overall and among nonsmokers (ORs of 1.3 to 1.5). Risk estimates for both smoking and consuming caffeine were less than the sum of the excess risks for each exposure. We observed an inverse trend between coffee intake and risk of atrial septal defect; however, this single significant pattern of association might have been a chance finding.

CONCLUSIONS

Our study found no evidence for an appreciable teratogenic effect of caffeine with regard to CVMs.

Strategies to improve sleep during extended search and rescue operations

OBJECTIVE

This study investigated strategies to improve sleeping conditions during search and rescue operations during disaster response.

METHODS

Forty members of the Montgomery County (Maryland) Urban Search and Rescue Team were surveyed for individual sleep habits and sleeping aids used during extended deployments. Team members were also asked to suggest methods to improve sleep on future deployments.

RESULTS

The average amount of sleep during field operations was 5.4 hours with a range of 4-8 hours. Eight percent surveyed would prefer another schedule besides the 12-hour work day, all of whom proposed three 8-hour shifts. Fifteen percent of participants were interested in a pharmacological sleeping aid. Fifty percent of search and rescue members interviewed would consider using nonpharmacological sleeping aids. Furthermore, 40% of participants stated they had successfully devised self-employed methods of sleep aids for previous deployments, such as ear plugs, massage, mental imagery, personal routines, music and headphones, reading, and blindfolds.

CONCLUSIONS

This study suggests that availability of both pharmacological and nonpharmacological sleeping aids to search and rescue workers via the team cache could impact the quantity of sleep. Further investigation into methods of optimizing sleep during field missions could theoretically show enhanced performance through various aspects of missions including mitigation of errors, improved productivity, and improved overall physiological and emotional well-being of search and rescue personnel.

The antimutagenic activity of the major flavonoids of rooibos (Aspalathus linearis): some dose-response effects on mutagen activation-flavonoid interactions

The antimutagenic properties of the most prevalent flavonoids in rooibos (Aspalathus linearis) were compared in the Salmonella typhimurium mutagenicity assay using tester strains TA98 and TA100 with, respectively, 2-acetamido-fluorene (2-AAF) and aflatoxin B(1) (AFB(1)) as mutagens in the presence of metabolic activation. The flavonoids included the dihydrochalcones aspalathin and nothofagin and their flavone analogues, orientin and isoorientin, and vitexin and isovitexin, respectively, as well as luteolin, chrysoeriol, (+)-catechin, quercetin, isoquercitrin, hyperoside and rutin. Flavonoid-mutagen interactions ranged from antimutagenic, comutagenic and promutagenic to mutagenic, while dose-response effects were mutagen-specific and ranged from typical to atypical including biphasic and threshold effects. Aspalathin and nothofagin and their structural flavonoid analogues displayed moderate antimutagenic properties while luteolin and to some extent, chrysoeriol, showed activities comparable to those of the green tea flavonoid (-) epigallocatechin gallate (EGCG). Apart from their mutagenic and promutagenic properties, quercetin and isoquercitrin exhibited concentration-dependent comutagenic and/or antimutagenic effects against 2-AAF- and AFB(1)-induced mutagenesis. Different structural parameters known to affect the antimutagenic properties of flavonoids include their hydrophilic or lipophilic nature due to the extent of hydroxylation and O-methylation, glycosylation on the A and B rings, the C4-keto group and the C2-C3 double bond. The C ring does not appear to be a prerequisite when comparing for the antimutagenic activity of the dihydrochalcones when compared of the dihydrochalcones with the structural flavone analogues.

Is coffee a functional food?

Definitions of functional food vary but are essentially based on foods' ability to enhance the quality of life, or physical and mental performance, of regular consumers. The worldwide use of coffee for social engagement, leisure, enhancement of work performance and well-being is widely recognised. Depending on the quantities consumed, it can affect the intake of some minerals (K, Mg, Mn, Cr), niacin and antioxidant substances. Epidemiological and experimental studies have shown positive effects of regular coffee-drinking on various aspects of health, such as psychoactive responses (alertness, mood change), neurological (infant hyperactivity, Alzheimer's and Parkinson's diseases) and metabolic disorders (diabetes, gallstones, liver cirrhosis), and gonad and liver function. Despite this, most reviews do not mention coffee as fulfilling the criteria for a functional food. Unlike other functional foods that act on a defined population with a special effect, the wide use of coffee-drinking impacts a broad demographic (from children to the elderly), with a wide spectrum of health benefits. The present paper discusses coffee-drinking and health benefits that support the concept of coffee as a functional food.

Dietary fiber in brewed coffee

Coffee beans are rich in nondigestible polysaccharides (dietary fiber), which may partially pass into brewed coffee; however, to the authors' knowledge, there is not enough literature on dietary fiber in brewed coffee. A specific method to determine dietary fiber in beverages (enzymatic treatment plus dialysis) was applied to the coffees brewed by the most common methods (espresso, filter, soluble); results showed that brewed coffee contained a significantly higher amount of soluble dietary fiber (0.47-0.75 g/100 mL of coffee) than other common beverages. Coffee dietary fiber contains a large amount of associated antioxidant phenolics (8.7-10.5 mg/100 mL of brewed coffee).

Effect of caffeine on the risk of coronary heart disease- A re-evaluation

The effect of caffeine intake on the risk of coronary heart disease was studied. Twenty-one rats used were randomly divided into three experimental groups, the first group served as the control while the second and third groups were administered caffeine orally at doses of 10mg/kg body weight and 20mg/kg body weight respectively for fourteen days. Caffeine, at 10mg/kg body weight, significantly increased (P<0.05) serum LDL- cholesterol concentration and coronary heart disease risk ratio while it significantly reduced (P<0.05) serum triacylglycerol concentration when compared with controls. At 20mg/kg body weight, caffeine significantly increased (P<0.05) coronary heart disease risk ratio while it significantly reduced (P<0.05) serum HDL-cholesterol concentration and serum triacylgycerol concentration when compared with controls. No dose response effect was observed possibly suggestive of a threshold effect. These results suggest that caffeine predisposes consumers of caffeine containing beverages to coronary heart disease.

Green tea and stroke prevention: Emerging evidence

BACKGROUND

Stroke is a leading cause of morbidity and mortality in many countries. Green tea is a simple and inexpensive beverage that is showing promise in the prevention of several diseases, including stroke. However, epidemiological studies examining the preventive effects of tea on stroke have generated inconsistent results.

OBJECTIVE

To review the emerging evidence for green tea in stroke prevention.

METHODS

Published articles were located by searching the PubMed, ProQuest, CINAHL and other databases, using the keywords 'tea' and 'stroke' with no restriction on publication date. Reference lists of identified articles were also searched for relevant publications.

RESULTS

Two published epidemiological studies on green tea reported positive findings. A large number of studies have also proposed biological mechanisms by which tea or tea components may reduce the stroke risk. Additional studies are required from a variety of populations, assessing duration and different types of tea consumption on subtypes of stroke to provide further evidence.

CONCLUSION

Green tea is a safe and cheap beverage. Its consumption should be encouraged because it could potentially serve as a practical method for stroke prevention.

Effect of reducing caffeine intake on birth weight and length of gestation: randomised controlled trial

OBJECTIVE

To estimate the effect of reducing caffeine intake during pregnancy on birth weight and length of gestation.

DESIGN

Randomised double blind controlled trial.

SETTING

Denmark.

PARTICIPANTS

1207 pregnant women drinking at least three cups of coffee a day, recruited before 20 weeks' gestation.

INTERVENTIONS

Caffeinated instant coffee (568 women) or decaffeinated instant coffee (629 women).

MAIN OUTCOME MEASURES

Birth weight and length of gestation.

RESULTS

Data on birth weight were obtained for 1150 liveborn singletons and on length of gestation for 1153 liveborn singletons. No significant differences were found for mean birth weight or mean length of gestation between women in the decaffeinated coffee group (whose mean caffeine intake was 182 mg lower than that of the other group) and women in the caffeinated coffee group. After adjustment for length of gestation, parity, prepregnancy body mass index, and smoking at entry to the study the mean birth weight of babies born to women in the decaffeinated group was 16 g (95% confidence interval -40 to 73) higher than those born to women in the caffeinated group. The adjusted difference (decaffeinated group-caffeinated group) of length of gestation was -1.31 days (-2.87 to 0.25).

CONCLUSION

A moderate reduction in caffeine intake in the second half of pregnancy has no effect on birth weight or length of gestation.

TRIAL REGISTRATION

Clinical Trials NCT00131690 [ClinicalTrials.gov].

An examination of consumer exposure to caffeine from retail coffee outlets

OBJECTIVE

To analyse the distribution of caffeine doses obtainable from espresso coffee sold by a sample of commercial coffee vendors located on the Gold Coast, Qld, Australia.

DESIGN

A cross section of "Espresso/short black" coffee samples were purchased and analysed for their caffeine content using micellar electrokinetic capillary chromatography (MEKC). Coffees were collected using systematic cluster sampling across five major retail centres.

RESULTS

Ninety-seven espresso samples were analysed. The mean (+/-SD) quantity of caffeine was 106+/-38 mg/serve with a concentration of 2473+/-1092 mg/l. There was considerable variation in caffeine content. The range per serve was 25-214 mg whilst the concentration range was 580-7000 mg/l. Twenty-four samples (24.7%) contained 120 mg of caffeine or higher and 12 samples (12.3%) exceeded 167 mg per serve.

CONCLUSIONS AND IMPLICATIONS

The number of heavily caffeinated samples differentiates these findings from frequently cited caffeine values and supports similar data recently collected throughout the United Kingdom. As a result, the accuracy of any previous intake modelling regarding caffeine use in the Australian population is in doubt. The present data suggests that the probability of consumer exposure to high caffeine doses is greater than previously anticipated. Greater sample numbers from a broader selection of venues is required to confirm the extent of caffeine content variance within retail ground coffees.

Survey of caffeine levels in retail beverages in Portugal

The caffeine content of 85 retail beverage samples purchased from local supermarkets between 1995 and 2004 was determined. The potential intake of caffeine through the consumption of these beverages (but excluding coffee) was estimated for students of the University of Coimbra, Portugal. The caffeine content of the beverages ranged from 47.5 to 282.5 mg l(-1) for teas, from 20.1 to 47.2 mg l(-1) for tea extracts samples, and from 80.7 to 168.7 mg l(-1) for cola soft drinks. Caffeine was not completely absent from caffeine-free colas, and energy drinks had a far greater caffeine content than regular drinks, ranging from 21 to 2175 mg l(-1). Soft drinks were consumed by 72% of the individuals, although 14% of the survey participants did not drink any of the different types of the beverages studied. Contrary to expectations for this age group, no consumptions of energy drinks was reported. Daily caffeine intake was estimated to range from 4.7 to 200 mg day(-1), but with only 5% reporting a daily intake around 200 mg caffeine. Cola-type beverages were an important dietary source of caffeine for the population studied. Statistical differences in the caffeine intake between the male and female populations were found, with p = 0.014, being higher for the male population. Of the beverages studied, cola-type drinks showed statistical differences for the male population, p = 0.03, and tea showed statistical differences for female population p = 0.013, respectively.

Oral clefts and life style factors — A case-cohort study based on prospective Danish data

This study examines the association between oral clefts and first trimester maternal lifestyle factors based on prospective data from the Danish National Birth Cohort. The cohort includes approximately 100,000 pregnancies. In total 192 mothers gave birth to child with an oral cleft during 1997-2003. Information on risk factors such as smoking, alcohol consumption, tea, coffee, cola, and food supplements was obtained during pregnancy for these and 828 randomly selected controls. We found that first trimester maternal smoking was associated with an increased risk of oral clefts (odds ratio (OR): 1.50; 95% confidence interval (CIs): 1.05, 2.14). Although not statistically significant, we also saw associations with first trimester consumption of alcohol (OR: 1.11; CIs: 0.79, 1.55), tea (OR: 1.31; CIs: 0.93, 1.86), and drinking more than 1 l of cola per week (OR: 1.40; CIs: 0.92, 2.12). Furthermore supplementation with > or =400 mcg folic acid daily during the entire first trimester (OR: 0.75; CIs: 0.46, 1.22) suggested an inverse associated with oral clefts, similar to our results on coffee drinking. No effects were found for smaller doses of folic acid, vitamin A, B6 or B12 in this study. The present study found an association between oral clefts and smoking and, although not conclusive, supports an association of oral cleft with alcohol.

Coffee, caffeine, and coronary heart disease

PURPOSE OF REVIEW

This review summarizes and highlights recent advances in current knowledge of the relationship between coffee and caffeine consumption and risk of coronary heart disease. Potential mechanisms and genetic modifiers of this relationship are also discussed.

RECENT FINDINGS

Studies examining the association between coffee consumption and coronary heart disease have been inconclusive. Coffee is a complex mixture of compounds that may have either beneficial or harmful effects on the cardiovascular system. Randomized controlled trials have confirmed the cholesterol-raising effect of diterpenes present in boiled coffee, which may contribute to the risk of coronary heart disease associated with unfiltered coffee consumption. A recent study examining the relationship between coffee and risk of myocardial infarction incorporated a genetic polymorphism associated with a slower rate of caffeine metabolism and provides strong evidence that caffeine also affects risk of coronary heart disease. Several studies have reported a protective effect of moderate coffee consumption, which suggests that coffee contains other compounds that may be beneficial.

SUMMARY

Diterpenes present in unfiltered coffee and caffeine each appear to increase risk of coronary heart disease. A lower risk of coronary heart disease among moderate coffee drinkers might be due to antioxidants found in coffee.

Catechol-o-methyltransferase gene polymorphism modifies the effect of coffee intake on incidence of acute coronary events

Background

The role of coffee intake as a risk factor for coronary heart disease (CHD) has been debated for decades. We examined whether the relationship between coffee intake and incidence of CHD events is dependent on the metabolism of circulating catecholamines, as determined by functional polymorphism of the catechol-O-methyltransferase (COMT) gene.

Methodology/Principal Findings

In a cohort of 773 men who were 42 to 60 years old and free of symptomatic CHD at baseline in 1984–89, 78 participants experienced an acute coronary event during an average follow-up of 13 years. In logistic regression adjusting for age, smoking, family history of CHD, vitamin C deficiency, blood pressure, plasma cholesterol concentration, and diabetes, the odds ratio (90% confidence interval) comparing heavy coffee drinkers with the low activity COMT genotype with those with the high activity or heterozygotic genotypes was 3.2 (1.2–8.4). Urinary adrenaline excretion increased with increasing coffee intake, being over two-fold in heavy drinkers compared with nondrinkers (p = 0.008 for trend).

Conclusions/Significance

Heavy coffee consumption increases the incidence of acute coronary events in men with low but not high COMT activity. Further studies are required to determine to which extent circulating catecholamines mediate the relationship between coffee intake and CHD.

Neonatal caffeine administration causes a permanent increase in the dendritic length of prefrontal cortical neurons of rats

We studied the morphological changes of the dendritic length of the pyramidal neurons of the prefrontal cortex (PFC) induced by the effect of chronic administration of caffeine in the neonatal rat. The caffeine (50 mg/kg, s.c.) was injected from day 1 after birth (P1) to day 12 (P12). The morphology of the pyramidal neurons of layer 3 of the PFC was investigated in these animals at two different ages, before puberty (P35) and after puberty (P70). Before the animals were sacrificed by using overdoses of sodium pentobarbital and being perfused intracardially with 0.9% saline, the locomotor activity in a novel environment was measured. The brains were then removed, processed by the Golgi-Cox stain, and analyzed by the Sholl method. The dendritic morphology clearly showed that the neonatal animals administered caffeine showed an increase in the dendritic length of the pyramidal neurons of the PFC when compared with the control animals at both ages. The present results suggest that neonatal administration of caffeine may in part affect the dendritic morphology of the pyramidal cells of this limbic structure and this effect persists after puberty and may be implicated in several brain processes.