Association of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Coffee Consumption With All-Cause and Cause-Specific Mortality : A Large Prospective Cohort Study

Association Between Dietary Betaine Intake and Dyslipidemia in Chinese Children and Adolescents: A Cross-Sectional Study

Background: Evidence remains limited on the effects of dietary betaine intake and dyslipidemia. We aim to investigate the association between dietary betaine intake and dyslipidemia in Chinese children and adolescents and illustrate the differences in these associations stratified by different food sources. Methods: Based on a national cross-sectional study from the China National Nutrition and Health Surveillance of Children and Lactating Mothers, 11,452 individuals aged 6-17 years were enrolled between October 2016 and December 2018. Participants were divided into quartiles according to residual energy-adjusted dietary betaine intake. The associations of dietary betaine with dyslipidemia and lipid profiles were estimated using restricted cubic spline regression and logistic regression analysis. Results: Among the 11,452 participants, 2577 (22.5%) individuals were found to have dyslipidemia. The median (IQR) intake of dietary betaine was 56.35 (25.77, 207.66) mg/day. Negative dose-dependent associations were found between residual energy-adjusted dietary betaine intake and dyslipidemia. Compared with participants in the lowest quartile (Q1) of residual energy-adjusted betaine intake, participants in the fourth quartile (Q4) had lower odds of high total cholesterol (TC), high low-density lipoprotein cholesterol (LDL-C), high non-high-density lipoprotein cholesterol (non-HDL-C), high remnant cholesterol (RC), and dyslipidemia, with odds ratios (OR) and 95% confidence intervals (95% CI) of 0.56 (0.45, 0.70), 0.65 (0.48, 0.87), 0.53 (0.41, 0.68), 0.42 (0.28, 0.61), and 0.79 (0.69, 0.91), respectively. Furthermore, reduced odds of high TC, high LDL-C, high non-HDL-C, high RC, and dyslipidemia were observed in dietary betaine from plant-source foods but not in animal-source foods. Conclusions: High intake of dietary betaine (56.35-207.66 mg/day) was associated with reduced odds of dyslipidemia, including elevated TC, LDL-C, non-HDL-C, and RC, and dietary betaine from plant-source foods revealed significant benefits for dyslipidemia in Chinese children and adolescents.

Habitual Coffee, Tea, and Caffeine Consumption, Circulating Metabolites, and the Risk of Cardiometabolic Multimorbidity

CONTEXT

Cardiometabolic multimorbidity (CM) is an increasing public health concern. Previous observational studies have suggested inverse associations between coffee, tea, and caffeine intake and risks of individual cardiometabolic diseases; however, their associations with CM and related biological markers are unknown.

METHODS

This prospective study involved 172 315 (for caffeine analysis) and 188 091 (tea and coffee analysis) participants free of any cardiometabolic diseases at baseline from the UK Biobank; 168 metabolites were measured among 88 204 and 96 393 participants. CM was defined as the coexistence of at least 2 of the following conditions: type 2 diabetes, coronary heart disease, and stroke.

RESULTS

Nonlinear inverse associations of coffee, tea, and caffeine intake with the risk of new-onset CM were observed. Compared with nonconsumers or consumers of less than 100 mg caffeine per day, consumers of moderate amount of coffee (3 drinks/d) or caffeine (200-300 mg/d) had the lowest risk for new-onset CM, with respective hazard ratios (95% CIs) of 0.519 (0.417-0.647) and 0.593 (0.499-0.704). Multistate models revealed that moderate coffee or caffeine intake was inversely associated with risks of almost all developmental stages of CM, including transitions from a disease-free state to single cardiometabolic diseases and subsequently to CM. A total of 80 to 97 metabolites, such as lipid components within very low-density lipoprotein, histidine, and glycoprotein acetyls, were identified to be associated with both coffee, tea, or caffeine intake and incident CM.

CONCLUSION

Habitual coffee or caffeine intake, especially at a moderate level, was associated with a lower risk of new-onset CM and could play important roles in almost all transition phases of CM development. Future studies are warranted to validate the implicated metabolic biomarkers underlying the relation between coffee, tea, and caffeine intake and CM.

Coffee Consumption and Mortality Among U.S. Adults: A Prospective Cohort Study

BACKGROUND

While coffee consumption has been associated with a variety of health benefits, it remains unclear whether the addition of sugar and saturated fat modifies these effects.

OBJECTIVE

To examine the relationship between coffee intake, including the amount of added sugar and saturated fat, and mortality among U.S. adults.

METHODS

We conducted a prospective cohort study using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, linked to National Death Index Mortality Data. The study included 46,332 adults aged 20 years and older who completed valid first-day 24-hour dietary recalls. Coffee consumption was categorized by type (caffeinated or decaffeinated) and by sugar (<2.5g per 8-oz), and saturated fat content (<1g per 8-oz). Mortality outcomes included all-cause, cancer, and cardiovascular disease (CVD) mortality. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality risk based on type, intake levels (non-drinkers, <1 cup/day, 1 to <2 cups/day, 2 to <3 cups/day, and ≥3 cups/day) and the amount of added sugar and saturated fat.

RESULTS

Over a median follow-up of 9.3 to 11.3 years, a total of 7,074 deaths occurred, including 1,176 cancer-specific and 1,089 CVD-specific deaths. Higher coffee consumption was associated with lower all-cause mortality (HR [95% CI]: 0.89 [0.78, 1.02] for < 1 cup/d; 0.84 [0.77, 0.92] for 1 to <2 cups/d; 0.83 [0.75,0.93] for 2 to < 3 cups/d; and 0.85 [0.77, 0.95] for ≥3 cups/day; P-trend= 0.004). However, the mortality benefits were restricted to black coffee (HR [95% CI]: 0.86 [0.77, 0.97]) and coffee with low added sugar and saturated fat content (HR [95% CI]: 0.86 [0.75,0.99]).

CONCLUSION

The health benefits of coffee consumption may be diminished when sugar and saturated fat are added.

Evaluation of the Association Between Coffee Consumption, Including Type (Instant, Ground), and Addition of Milk or Sweeteners and New-Onset Hypertension and Potential Modifiers

BACKGROUND

The association between coffee consumption and incident hypertension remained inconsistent.

OBJECTIVE

This study aimed to examine the association of consumption of coffee, including different types (instant and ground) and with different additives, with new-onset hypertension, and evaluate whether genetic variation in caffeine metabolism and inflammation may modify the association.

DESIGN

This study utilized a prospective cohort design.

PARTICIPANTS/SETTING

A total of 98 765 participants free of hypertension enrolled in the UK Biobank between 2006 and 2010 were included. Dietary coffee consumption was collected using 24-hour dietary recall questionnaires.

MAIN OUTCOME MEASURES

The study outcome was new-onset hypertension, ascertained by self-reported medical conditions, hospital inpatient records, death registers, and primary care records.

STATISTICAL ANALYSES PERFORMED

Cox proportional hazards models were used to estimate hazard ratio and 95% CI. Potential modifying effects were assessed by likelihood ratio testing.

RESULTS

During a median follow-up of 12.1 years, 7090 (7.2%) new-onset cases of hypertension were documented. Overall, regardless of coffee type (instant or ground) and whether adding milk to coffee, there was a U-shaped association between unsweetened coffee consumption and new-onset hypertension, with a 14% to 18% reduction of hypertension risk at >1 to ≤4 drinks per day, whereas a null association was observed between sweetened coffee consumption and the risk of new-onset hypertension. Relative to coffee nonconsumers, the adjusted hazard ratio (95% CI) of new-onset hypertension for participants who drinking unsweetened coffee 1 or fewer, >1 to 2, >2 to 3, >3 to 4, and >4 drinks/day were 0.92 (95% CI 0.85 to 1.00), 0.82 (95% CI 0.76 to 0.89), 0.86 (95% CI 0.79 to 0.96), 0.86 (95% CI 0.77 to 0.96), and 0.88 (95% CI 0.78 to 0.99), respectively. Moreover, a stronger inverse association between moderate consumption of unsweetened coffee and new-onset hypertension was found in participants with higher C-reactive protein levels (P for interaction =.012), whereas an individual's genetic variation in caffeine metabolism did not significantly modify the association (P for interaction = .453).

CONCLUSIONS

Regardless of the type of coffee (instant or ground) or the addition of milk to coffee, moderate consumption of unsweetened coffee (>1 to ≤4 drinks/day), but not sweetened coffee, was associated with a lower risk of new-onset hypertension.

Association between adherence to the EAT-Lancet diet and risk of microvascular complications in type 2 diabetes: A cohort study

AIM

This study aimed to investigate the association between adherence to the EAT-Lancet diet and the incidence of microvascular complications in type 2 diabetes (T2D).

MATERIALS AND METHODS

This prospective study included 7525 individuals with T2D who were free of diabetic microvascular complications (including diabetic retinopathy, neuropathy and nephropathy) at baseline from the UK Biobank cohort. Dietary data were collected via a web-based 24-hour dietary recall questionnaire. The EAT-Lancet diet index, ranging from 0 to 14 points, was constructed based on the EAT-Lancet reference diet. Cox proportional hazard models were used to examine the relationship between the EAT-Lancet diet index and the incidence of microvascular complications among individuals with T2D.

RESULTS

During a mean follow-up of 12.58 years, 1217 participants developed diabetic microvascular complications. After adjusting for potential confounders, participants in the highest adherence group of the EAT-Lancet diet index had a significantly lower risk of developing microvascular complications (hazard ratio: 0.76, 95% CI: 0.64-0.88) compared to those in the lowest adherence group. Subtype analyses for incident diabetic retinopathy, neuropathy and nephropathy yielded consistent results. Additionally, each 1-point increase in the EAT-Lancet diet index was associated with an 8% lower risk of microvascular complications. These findings remained robust across several sensitivity analyses and nearly all subgroups.

CONCLUSION

Our findings demonstrate a significant inverse association between adherence to the EAT-Lancet diet and the risk of microvascular complications in individuals with T2D.

Association between daily coffee intake and diabetic kidney disease: evidence from the 2007 to 2016 NHANES

PURPOSE

Regular coffee intake is recognized as a protective factor against various chronic diseases, particularly diabetes. However, the correlation between coffee intake-both the act of drinking coffee and the amount consumed-and diabetic kidney disease (DKD) remains uncertain. The goal of this study is to measure the correlation between coffee intake and DKD.

METHODS

This cross-sectional study was based on data from the 2007 to 2016 National Health and Nutrition Examination Survey (NHANES). DKD was characterized by the coexistence of diabetes combined with impaired glomerular filtration rate (eGFR < 60 mL/min/1.73 m2) or ACR ≥ 30 mg/g. Weighted logistic regression and restricted cubic spline (RCS) analyses were adopted to evaluate the correlation between coffee intake and DKD. The subgroup analyses were implemented to assess the reliability of the results.

RESULTS

The study included 13,177 participants, representing a weighted population of 125,388,198 individuals. Among them, 8198 (64%) participants consumed coffee and 1430 (7.6%) were classified as having DKD. After controlling for covariates, multivariable logistic regression showed a negative correlation between moderate coffee intake and DKD (OR = 0.68; 95% CI: 0.55-0.83; P < 0.001). The RCS analysis suggested a U-shaped, non-linear correlation between coffee intake and DKD (P overall = 0.013; P nonlinear = 0.047). The subgroup analyses further supported the stability and reliability of these findings.

CONCLUSION

The results indicate a U-shaped correlation between coffee intake and diabetic kidney disease.

Systematic analysis of relationships between serum lipids with all-cause and cause-specific mortality: Evidence from prospective cohort studies of UK Biobank and Women's Health Initiative

BACKGROUND & AIMS

Serum lipids, including lipoproteins, cholesterol, and triglycerides, are important modifiable factors influencing human health. However, the associations among different serum lipid profiles and mortality remain insufficiently understood, particularly regarding potential causality and population heterogeneity. This prospective study aims to systematically investigate the relationships between serum lipid concentrations of different densities and sizes with all-cause and cause-specific mortality.

METHODS

Cox proportional and Fine-Gray subdistribution hazard models were applied to investigate the associations of 54 lipid concentrations with all-cause and cause-specific mortality (including cardiovascular disease (CVD), cancer, and respiratory disease) in the UK Biobank cohort of 441,448 individuals with 17-year follow-up. Cohorts of 120,967 and 44,168 individuals from the Women's Health Initiative (WHI) with 16-year follow-up and a large-scale meta-analysis were utilized for external replication. We further assessed the underlying causality using Mendelian randomization (MR) and possible modifiers using multiple subgroup analyses.

RESULTS

During a median follow-up of 13.8 years, 39,290 deaths occurred, including 7399 from CVD, 18,928 from cancer, and 2707 from respiratory disease. We identified 160 significant associations between lipid concentrations and all-cause and cause-specific mortality. Importantly, most were inverse, with decreased lipid levels linked to increased risk of premature death [hazard ratios (HRs): 0.70-0.98 per standard deviation (SD)]. In contrast, positives were observed for HDL (large/very large) and triglyceride concentrations [HRs: 1.02-1.25 per SD], indicating increased mortality risk with higher levels. Most lipoproteins and cholesterol exhibited nonlinearly correlations with mortality, especially the significant U-shaped in total/HDL. However, MR showed that elevations in several lipids were associated with increased all-cause and CVD-specific mortality risk. Multiple subgroup analyses revealed that age, sex, and lipid-modifying drugs modified the lipid-mortality relationship; specifically, higher lipid concentrations increased mortality risk in younger adults not taking lipid-modifying drugs, but decreased mortality in older adults taking lipid-modifying drugs. The majority of associations were replicated in the WHI and external cohorts.

CONCLUSION

Our study systematically reported a large number of associations between serum lipid concentrations and mortality. Subgroup-based population heterogeneity analysis suggests that age, sex, and lipid-modifying drugs could be modifiers for the lipid-mortality relationship. These findings provide more guidance for lipid management and individualized prevention.

Consumption of Unsweetened Coffee or Tea May Reduce the Cancer Incidence and Mortality: A Prospective Cohort Study

BACKGROUND

Current evidence on the relationship between beverage intake and cancer risk remains inconclusive.

OBJECTIVES

This study aimed to examine the association between the intake of 11 beverages and cancer incidence and mortality, with a particular focus on coffee and tea, categorized by their sugar content.

METHODS

This large prospective cohort study included 189,020 participants from the United Kingdom Biobank. Multivariate Cox proportional hazard models were used to assess the association between beverage intake and the incidence and mortality of overall cancer and cancers of various systems. Additionally, the study investigated the effects of substituting 1 beverage for another and explored potential mediators underlying the relationship between beverage intake and cancer outcomes.

RESULTS

Over a median follow-up period of 8.8 y, consuming >2 cups of unsweetened coffee per day was associated with reduced overall cancer incidence and mortality. Compared with no intake of unsweetened coffee, the hazard ratios (HRs) were 0.95 [95% confidence interval (CI): 0.92, 0.98] for overall cancer incidence and 0.89 (95% CI: 0.83, 0.96) for overall cancer mortality. Similarly, consuming >2 cups of unsweetened tea per day was associated with reduced overall cancer incidence (HR: 0.94, 95% CI: 0.92, 0.97) and mortality (HR: 0.84, 95% CI: 0.79, 0.91) compared with no unsweetened tea intake. Substituting unsweetened coffee or tea for other beverages was associated with a 1%-5% reduction in overall cancer incidence and mortality. The association between unsweetened tea and reduced cancer risk may be partially mediated by inflammatory markers. Notably, the sugar content of coffee and tea had the most pronounced effect on risk of respiratory system cancers.

CONCLUSIONS

Beverage selection significantly impacts cancer incidence and mortality. For cancer prevention, unsweetened tea or coffee may be the optimal choice.

Coffee Consumption, Additive Use, and Risk of Type 2 Diabetes-Results from 3 Large Prospective United States Cohort Studies

BACKGROUND

Consumption of coffee has been consistently associated with lower risk of type 2 diabetes (T2D). However, it is unknown whether the use of additives may modify the association.

OBJECTIVES

This study aimed to analyze the association between coffee consumption and risk of T2D by considering the addition of sugar, artificial sweeteners, cream, or a nondairy coffee whitener.

METHODS

We used 3 large prospective cohorts-Nurses' Health Study (NHS; 1986-2020), NHS II (1991-2020), and the Health Professionals Follow-up Study (HPFS 1991-2020). Self-reported coffee consumption, additive use, and T2D incidence were confirmed using validated questionnaires. Time-dependent Cox proportional hazards regression models were used to calculate hazard ratios (HRs) with multivariable adjustment.

RESULTS

During 3,665,408 person-years of follow-up, we documented 13,281 incident T2D cases. After multivariable adjustment, each additional cup of coffee without any additive was associated with 10% lower risk of T2D (HR: 0.90; 95% CI: 0.89, 0.92) in the pooled analysis of the 3 cohorts. The inverse association did not change among participants who added cream. Among participants who added sugar to coffee (on average 1 teaspoon per cup), the association was significantly weakened (HR: 0.95; 95% CI: 0.93, 0.97; interaction term HR: 1.17; 95% CI: 1.07, 1.27). A similar pattern was observed among those who used artificial sweeteners (HR: 0.93; 95% CI: 0.90, 0.96; interaction term HR: 1.13; 95% CI: 1.00, 1.28). The association between coffee consumption and T2D risk among those who used coffee whitener was also attenuated, although the interaction was not significant (HR: 0.95; 95% CI: 0.91, 1.00; interaction term HR: 1.16; 95% CI: 0.66, 2.06).

CONCLUSIONS

Adding sugar or artificial sweetener significantly attenuates the magnitude of the inverse association between higher coffee consumption and T2D risk, whereas the use of cream do not alter the inverse association.

Association of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Coffee Consumption with Chronic Liver Disease and Liver-Related Events: A Large Prospective Cohort Study

BACKGROUND

Previous observational studies have not reached an agreement on the association between coffee consumption and risk of liver diseases. Also, none of these studies took sweetener added in coffee into consideration.

OBJECTIVES

We aim to explore the associations of consumption of sweetened and unsweetened coffee with chronic liver disease (CLD) and liver-related events (LREs), and evaluate the degree to which sweetener added counteracted the effect of coffee.

METHODS

We performed a longitudinal cohort study of 170,044 participants without liver diseases or cancer at baseline investigation (2006-2010) and followed until 2022. Consumption of coffee and sweetener was assessed by 24-h dietary recall questionnaire. Cox proportional hazards models and restricted cubic splines were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

During a median follow-up of 12.4 y, we identified 4152 incident of CLD and 853 LREs. Compared with nonconsumers, unsweetened coffee consumers of various amount had lower risk of CLD (HR: 0.75; 95% CI: 0.67, 0.83 for 1.5∼2.5 drinks/d) and LREs (HR: 0.60; 95% CI: 0.46, 0.80 for 2.5∼3.5 drinks/d) in the multivariable Cox models. U-shaped associations of unsweetened coffee with CLD and LREs were observed. The results for sweetened coffee were less consistent and conclusive in both CLD and LREs. We detected positive associations between sweetener and CLD and LREs. Compared with unsweetened coffee consumers, consumers of different amount of sugar added to coffee had higher risk of CLD in the multivariable Cox model. For artificial sweetener, a significant higher risk of CLD (HR: 1.61; 95% CI: 1.25, 2.05)and LREs (HR: 1.82; 95% CI: 1.11, 2.98) was only found in those who added ≥2 teaspoons/drink. We detected significant interaction between artificial sweetener and coffee intake on the risk of CLD (HR for product term: 0.76; 95% CI: 0.60, 0.96; P = 0.018; relative excess risk due to interaction: -0.32; 95% CI: -0.58, -0.06).

CONCLUSIONS

Moderate consumption of unsweetened coffee was associated with lower risk of CLD and LREs. Adding sweetener into coffee could bring additional risk of liver diseases in coffee consumers.

Coffee drinking timing and mortality in US adults

BACKGROUND AND AIMS

To identify the patterns of coffee drinking timing in the US population and evaluate their associations with all-cause and cause-specific mortality.

METHODS

This study included 40 725 adults from the National Health and Nutrition Examination Survey 1999-2018 who had complete information on dietary data and 1463 adults from the Women's and Men's Lifestyle Validation Study who had complete data on 7-day dietary record. Clustering analysis was used to identify patterns of coffee drinking timing.

RESULTS

In this observational study, two distinct patterns of coffee drinking timing [morning type (36% of participants) and all-day-type patterns (14% of participants)] were identified in the National Health and Nutrition Examination Survey and were validated in the Women's and Men's Lifestyle Validation Study. During a median (interquartile range) follow-up of 9.8 (9.1) years, a total of 4295 all-cause deaths, 1268 cardiovascular disease deaths, and 934 cancer deaths were recorded. After adjustment for caffeinated and decaffeinated coffee intake amounts, sleep hours, and other confounders, the morning-type pattern, rather than the all-day-type pattern, was significantly associated with lower risks of all-cause (hazard ratio: .84; 95% confidential interval: .74-.95) and cardiovascular disease-specific (hazard ratio: .69; 95% confidential interval: .55-.87) mortality as compared with non-coffee drinking. Coffee drinking timing significantly modified the association between coffee intake amounts and all-cause mortality (P-interaction = .031); higher coffee intake amounts were significantly associated with a lower risk of all-cause mortality in participants with morning-type pattern but not in those with all-day-type pattern.

CONCLUSIONS

Drinking coffee in the morning may be more strongly associated with a lower risk of mortality than drinking coffee later in the day.

Beverage consumption modifies the risk of type 2 diabetes associated with ambient air pollution exposure

BACKGROUND

Evidence on how beverage consumption modifies associations between air pollution (AP) exposure with the type 2 diabetes (T2D) risk remains scarce, which we aimed to investigate in this study.

METHODS

A total of 77,278 adults from the UK Biobank cohort were enrolled. Annual average concentrations of fine particulate matter (PM2.5 and PM10) and nitrogen oxides (NO2 and NOX) were estimated to represent the long-term AP exposure using the land use regression model. The consumption of beverages (alcoholic beverages, juice, sugar-sweetened beverages [SSB], coffee, and tea) was estimated with the 24-hour dietary assessment. The AP-T2D and beverage-T2D risks were assessed using Cox regression models. Modifying effects of beverage consumption on AP-T2D associations were evaluated through stratified analysis and heterogeneity test.

RESULTS

During a median follow-up of 12.19 years, 1486 T2D events were recorded. One interquartile range increase of PM2.5, NO2, and NOX raised the T2D risk with the hazard ratios (HR) and 95 % confidence intervals (95 % CI) being 1.09 (1.03, 1.16), 1.14 (1.06, 1.21), and 1.09 (1.04, 1.15), respectively. For beverages, compared with non-consumption, daily consumption (>0 cup) of red wine, > 0-3 cups of white wine, ground coffee, and herbal tea, and > 0-1 cup of spirits were associated with a 13 %-37 % reduced T2D risk, while > 0 cup of SSB were associated with a 21 %-122 % elevated T2D risk. Beverage consumption modified AP-T2D associations, as compared with non-consumption, > 0-3 cups of red wine, white wine, ground coffee, and herbal tea had a lower attenuated T2D risk associated with NO2 and/or NOX. Conversely, those with > 1 cup of SSB had a higher T2D risk associated with both NO2 and NOX (Pheter <0.05).

CONCLUSIONS

This study highlights the significant role of beverage consumption in mitigating or exacerbating the T2D risk associated with long-term NO2 and NOX exposure.

Association of caffeine intake and sleep duration with bone mineral density: a cross-sectional study from National Health and Nutrition Examination Survey between 2011 and 2018

OBJECTIVE

The association between sleep duration, caffeine intake, and bone mineral density (BMD) is not well understood, with previous studies providing controversial results. This study explores the associations among caffeine intake, sleep duration, and BMD.

METHODS

Data were sourced from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018, including 13,457 participants who self-reported sleep duration and caffeine intake, with BMD measured via dual X-ray absorptiometry. Multivariable linear regression models, adjusted for confounders, were used alongside restricted cubic splines to examine dose-response association.

RESULTS

Of all participants, 6821 (50.7%) were males and 6636 were females (49.3%). The mean caffeine intake and sleep duration were 93.4 mg/day and 7.19 h, respectively. RCS results showed that BMD increased with the increase in caffeine intake, especially in the low dose range of 0-200 mg/day. The dose-response association between sleep duration and BMD showed that sleep durations of 0-6 h may promote the increase of BMD, but after sleep durations greater than 6 h, BMD decreases. After adjustment for potential confounders, compared to the lowest referent quartile, individuals with caffeine intake in quartiles 2, 3, and 4 had a positive correlation with BMD (0.62 95% CI: 0.24-1.37; 0.51 95% CI: 0.22-1.13; 0.75 95% CI: 0.41-1.46; P for trend < 0.05). In covariate-adjusted linear regression models, compared with those sleeping 6 h or less per night, the difference in BMD among those sleeping 6-7 h, 7-8 h, and 8-14.5 h per night were 1.81 (95% CI: 0.4122.71), 1.25 (95% CI: 0.55-2.93), and 0.87 (95% CI: 0.38-1.69). Associations of caffeine intake, sleep duration, and BMD stratified by sex and age failed to reach statistical significance.

CONCLUSIONS

Association might exist between the consumption of caffeine, sleep duration, and BMD; however, when stratified by sex and age, the association did not reach statistical significance.

High consumption of artificially sweetened beverages and associated risk of cardiovascular events: A systematic review and meta-analysis

BACKGROUND

With the rising use of artificial sweeteners as sugar substitutes, concerns regarding their impact on cardiovascular health have emerged. Artificially sweetened beverages are the primary source of diet sweeteners, but despite approval by national food agencies, evidence of their association with cardiovascular events has not been conclusive. Our Meta-Analysis assessed the relationship between artificially sweetened beverage consumption and long-term outcomes of cardiovascular events in extended follow-up cohorts.

METHODS

Medline, Embase, and Cochrane databases were systematically searched for cohort studies investigating the incidence of all-cause mortality, cardiovascular mortality, stroke, and coronary heart disease among individuals with high consumption of ASB compared to minimal or no consumption. Pooled event hazard ratios with 95% confidence intervals were calculated using a random-effects model in R software, with heterogeneity assessed via I² statistics.

RESULTS

We included twelve prospective cohorts comprising 1,224,560 patients. Analyses were conducted on patient groups with data adjusted for co-founding, such as dietary factors and comorbidities. One or more daily dose of Artificially sweetened beverages was significantly associated with a higher risk of all-cause mortality (HR 1.14; 95% 1.03 to 1.26; p < 0.01;), Cardiovascular mortality (HR 1.29; 95% 1.1 to 1.53; p < 0.01), and stroke (HR 1.15; 95% 1.01 to 1.32; p = 0.04;).

CONCLUSION

In this meta-analysis, we found a significant association between high consumption of ASBs and increased incidence of ACM, CVD, and stroke, highlighting potential long-term cardiovascular implications.

Associations of dietary choline intake and kidney function with hyperuricemia in Chinese children and adolescents: a cross-sectional study

Background

Limited studies have suggested an effect of dietary choline intake on uric acid levels. We aim to investigate the associations between choline intake and hyperuricemia (HUA), as well as the mediating role of kidney function in this relationship, among the Chinese population aged 6-17 years.

Methods

Participants were divided into quartiles according to residual energy-adjusted dietary choline intake in our cross-sectional study. Dietary choline intake was assessed using the 24-h dietary recalls method over three consecutive days, including two weekdays and one weekend day. The primary outcome was the HUA prevalence. Based on recommendation in Clinical Paediatric Nephrology (3rd ed), HUA is defined based on fasting serum uric acid levels, with cutoffs varying by age and sex. The associations between choline intake and HUA were analysed using weighted logistic regression models, restricted cubic spline models, and linear regression models. The mediated proportions of estimated glomerular filtration rate (eGFR) in the associations were estimated with mediation effect models. The data for this study were collected from the China National Nutrition and Health Surveillance of Children and Lactating Mothers (2016-2017) conducted between October 2016 and December 2018. Eligible participants were identified through a database search conducted from October to December 2023.

Findings

Among the 10749 participants, 3398 (31.6%) individuals were found to have HUA. A negative dose-dependent relationship was found between dietary choline intake and HUA. Compared to participants in the lowest intake quartile of total choline, phosphatidylcholine, and betaine, those in the 4th quartile had lower odds of HUA, with odds ratio (OR) of 0.75 (95% confidence interval [95% CI], 0.63-0.90), 0.75 (95% CI, 0.64-0.89), and 0.75 (95% CI, 0.59-0.94), respectively. The eGFR mediated 10.60%-14.58% of the associations. Participants in the 4th quartile of lipid-soluble dietary choline exhibited 24.00% reduced odds of HUA compared to those in the lowest intake quartile, with an OR of 0.76 (95% CI, 0.64-0.90).

Interpretation

Moderate to high intake of dietary choline (181.20-357.92 mg/d), particularly phosphatidylcholine (120.22-207.58 mg/d), and betaine (189.24-282.37 mg/d), may reduce the odds of HUA by improving glomerular filtration function. Further interventional studies are needed to establish causal relationships.

Funding

This work was supported by the National Natural Science Foundation of China (82003443, 42375180), the Natural Science Foundation of Guangdong Province of China (2024A1515012088), and the Construction of High-level University of Guangdong (G624330422).

Coffee consumption and adverse cardiovascular events in patients with atrial fibrillation

BACKGROUND

There is some evidence of reduced major cardiovascular event (MACE) rates associated with moderate coffee consumption in the general population. However, there is concern about the potential risks of coffee consumption in patients with atrial fibrillation (AF). Therefore, we aimed to investigate the association between coffee consumption and MACE in AF patients.

METHODS

Data of patients with documented AF enrolled in two large prospective observational multicenter cohort studies (Swiss-AF and Beat-AF) were analyzed. Follow-up information was obtained on a yearly basis. Coffee consumption was categorized into two main groups: "daily" and "not-daily" coffee consumers as well as additional subcategories. The primary endpoint was MACE, defined as a composite of stroke or systemic embolism, myocardial infarction, hospitalization for acute heart failure, and cardiovascular mortality. Secondary endpoints were the individual components of MACE and all-cause mortality. We performed time-updated multivariable adjusted Cox regression analyses to investigate the association between coffee consumption and MACE.

RESULTS

The incidence rate for MACE was 5.09 per 100 person-years (py) in daily and 7.49 per 100 py in not-daily consumers (median follow-up duration: 4.7 years). After adjustment for pre-selected confounding variables, daily coffee consumption was associated with a 23% lower hazard for MACE compared to not-daily consumption (hazard ratio (HR) (95% confidence interval (CI)) 0.77 (0.66; 0.89)). Patients with moderate coffee consumption (2-3 cups/day) had the lowest hazard for MACE compared to patients with not-daily coffee consumption (HR (95% CI) 0.74 (0.63; 0.87)).

CONCLUSIONS

In a population of AF patients, daily coffee consumption was associated with a reduced risk for MACE, hospitalization for acute heart failure, and all-cause mortality. The results were inconclusive for stroke or systemic embolism, myocardial infarction, and cardiovascular death. In this analysis, we found no evidence of an unfavourable association of daily coffee consumption in AF Patients with adverse outcome events.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02105844.

Association of coffee consumption with cardiometabolic multimorbidity: A prospective cohort study in the UK biobank

BACKGROUND AND AIMS

Previous observational studies have investigated the association between coffee consumption and single cardiometabolic disease. Yet, the extent to which coffee might confer health advantages to individuals with a singular cardiometabolic disease remains unclear. This study aimed to further investigate the association of coffee consumption and the onset and progression from single cardiometabolic disease to cardiometabolic multimorbidity (CMM).

METHODS AND RESULTS

This prospective cohort study included 185,112 participants from the UK Biobank who were enrolled between 2006 and 2010 and followed up until 2020. Coffee consumption was collected using a 24-h dietary questionnaire. CMM was defined as the coexistence of at least two cardiometabolic diseases, including type 2 diabetes (T2D), coronary heart disease (CHD) and stroke. Cox proportional hazards and multi-state models estimated the associations between coffee consumption and CMM. During a median follow-up of 11.4 years, 1585 participants developed CMM. Compared with nonconsumers, coffee consumers had lower risks for the transitions from baseline to single cardiometabolic disease, with the respective lowest hazard ratios and 95% confidence intervals (CIs) for the transitions from baseline to T2D, CHD and stroke after multivariable adjustment being 0.79 (CI, 0.72-0.87), 0.91 (CI, 0.86-0.97) and 0.87 (CI, 0.78-0.96). Coffee consumption resulted in a significant reduction in the risk of the transitions from CHD and stroke to CMM, with the lowest estimates were 0.56 (CI, 0.43-0.73) and 0.60 (CI, 0.43-0.83). Similar associations were observed in unsweetened coffee. Sugar-sweetened coffee was associated with some transitions at low levels of consumption. The associations between artificially sweetened coffee and CMM were less consistent.

CONCLUSIONS

Coffee consumption was associated with lower risk for almost all transition phases of CMM development and consistent findings were observed with unsweetened coffee.

Tea Consumption, Milk or Sweeteners Addition, Genetic Variation in Caffeine Metabolism, and Incident Venous Thromboembolism

OBJECTIVE

 The association between tea consumption and venous thromboembolism (VTE) remains unknown. We aimed to evaluate the association between tea consumption with different additives (milk and/or sweeteners) and incident VTE, and the modifying effects of genetic variation in caffeine metabolism on the association.

METHODS

 A total of 190,189 participants with complete dietary information and free of VTE at baseline in the UK Biobank were included. The primary outcome was incident VTE, including incident deep vein thrombosis and pulmonary embolism.

RESULTS

 During a median follow-up of 12.1 years, 4,485 (2.4%) participants developed incident VTE. Compared with non-tea drinkers, tea drinkers who added neither milk nor sweeteners (hazard ratio [HR]: 0.85; 95% confidence interval [95% CI]: 0.76-0.94), only milk (HR: 0.86; 95% CI: 0.80-0.93), and both milk and sweeteners to their tea (HR: 0.90; 95% CI: 0.81-0.99) had a lower risk of VTE, while those who added only sweeteners to their tea did not (HR: 0.94; 95% CI: 0.75-1.17). Moreover, there was an L-shaped relationship between tea consumption and incident VTE among tea drinkers who added neither milk nor sweeteners, only milk, and both milk and sweeteners to their tea, respectively. However, a nonsignificant association was found among tea drinkers who added only sweeteners to their tea. Genetic variation in caffeine metabolism did not significantly modify the association (p-interaction = 0.659).

CONCLUSION

 Drinking unsweetened tea, with or without added milk, was associated with a lower risk of VTE. However, there was no significant association between drinking tea with sweeteners and incident VTE.

Impact of coffee intake on human aging: Epidemiology and cellular mechanisms

The conception of coffee consumption has undergone a profound modification, evolving from a noxious habit into a safe lifestyle actually preserving human health. The last 20 years also provided strikingly consistent epidemiological evidence showing that the regular consumption of moderate doses of coffee attenuates all-cause mortality, an effect observed in over 50 studies in different geographic regions and different ethnicities. Coffee intake attenuates the major causes of mortality, dampening cardiovascular-, cerebrovascular-, cancer- and respiratory diseases-associated mortality, as well as some of the major causes of functional deterioration in the elderly such as loss of memory, depression and frailty. The amplitude of the benefit seems discrete (17 % reduction) but nonetheless corresponds to an average increase in healthspan of 1.8 years of lifetime. This review explores evidence from studies in humans and human tissues supporting an ability of coffee and of its main components (caffeine and chlorogenic acids) to preserve the main biological mechanisms responsible for the aging process, namely genomic instability, macromolecular damage, metabolic and proteostatic impairments with particularly robust effects on the control of stress adaptation and inflammation and unclear effects on stem cells and regeneration. Further studies are required to detail these mechanistic benefits in aged individuals, which may offer new insights into understanding of the biology of aging and the development of new senostatic strategies. Additionally, the safety of this lifestyle factor in the elderly prompts a renewed attention to recommending the maintenance of coffee consumption throughout life as a healthy lifestyle and to further exploring who gets the greater benefit with what schedules of which particular types and doses of coffee.

Time from waking to the first cigarette and mortality and incident cardiovascular disease

BACKGROUND

This study aimed to investigate the associations of time from waking to the first cigarette (TWFC) with all-cause mortality, cardiovascular disease (CVD) mortality and incident CVD among people smoking.

METHODS

Data were from the UK Biobank, including 32 519 people smoking aged 40-70 years. TWFC was investigated using a touch-screen questionnaire. Outcomes included all-cause mortality and mortality from and incidence of CVD, ischemic heart disease (IHD) and stroke.

RESULTS

Compared with participants reporting TWFC >120 min, those reporting TWFC between 61 and 120 min (HR, 1.30; 95% CI, 1.10-1.53), TWFC between 5 and 60 min (1.48, 1.30-1.70) and TWFC <5 min (1.65, 1.42-1.93) had a higher risk of all-cause mortality. Compared with participants reporting TWFC >120 min, those reporting TWFC between 5 and 60 min and TWFC <5 min had higher risks of CVD and IHD mortality and incident CVD and IHD, but those reporting TWFC between 61 and 120 min did not. The associations of TWFC with stroke mortality and incident stroke were not observed.

CONCLUSION

In this cohort study, a shorter TWFC was associated with higher risks of all-cause mortality, mortality from CVD and IHD, as well as incident CVD and IHD.

Ultra-processed food, genetic risk, and the risk of cardiometabolic diseases and cardiometabolic multimorbidity: A prospective study

BACKGROUND AND AIMS

This study aims to evaluate the impact of ultra-processed food (UPF) on type 2 diabetes (T2D), cardiovascular disease (CVD), hypertension, and cardiometabolic multimorbidity (CMM), and to explore the role of genetic susceptibility in these associations.

METHODS AND RESULTS

90 631 participants from the UK Biobank were included (collected between 2006 and 2010). The outcomes assessed included T2D, CVD, hypertension and CMM. The Cox proportional hazards model was used to evaluate their associations and the potential modification by genetic risk, which was estimated using the polygenic risk score (PRS). Participants with high UPF consumption had a higher risk of T2D, CVD, and CMM, with the adjusted hazard ratio (HR) of 1.36 (95 % confidence interval [CI]: 1.15, 1.61), 1.13 (95%CI: 1.03, 1.23), and 1.14 (95%CI: 1.05, 1.24), respectively. Those with high UPF consumption and high PRS for T2D, CVD, and hypertension had the highest risk of T2D (HR: 4.01; 95%CI: 2.83, 5.69), CVD (HR: 2.18; 95%CI: 1.86, 2.56), and hypertension (HR: 1.79; 95%CI: 1.61, 1.99), respectively. In participants with one cardiometabolic disease (CMD), those with high UPF consumption and high PRST2D or PRSCVD had the highest risk of developing CMM. A significant additive interaction was observed between PRST2D and UPF consumption on the risk of T2D.

CONCLUSION

Our study underscored the importance of identifying individuals with high UPF consumption for targeted dietary interventions to mitigate the risk of CMDs and CMM, particularly among those with a high genetic risk of CMDs.

Coffee consumption is associated with intestinal Lawsonibacter asaccharolyticus abundance and prevalence across multiple cohorts

Although diet is a substantial determinant of the human gut microbiome, the interplay between specific foods and microbial community structure remains poorly understood. Coffee is a habitually consumed beverage with established metabolic and health benefits. We previously found that coffee is, among >150 items, the food showing the highest correlation with microbiome components. Here we conducted a multi-cohort, multi-omic analysis of US and UK populations with detailed dietary information from a total of 22,867 participants, which we then integrated with public data from 211 cohorts (N = 54,198). The link between coffee consumption and microbiome was highly reproducible across different populations (area under the curve of 0.89), largely driven by the presence and abundance of the species Lawsonibacter asaccharolyticus. Using in vitro experiments, we show that coffee can stimulate growth of L. asaccharolyticus. Plasma metabolomics on 438 samples identified several metabolites enriched among coffee consumers, with quinic acid and its potential derivatives associated with coffee and L. asaccharolyticus. This study reveals a metabolic link between a specific gut microorganism and a specific food item, providing a framework for the understanding of microbial dietary responses at the biochemical level.

Coffee Intake in Brazil Influences the Consumption of Sugar, Sweets, and Beverages

Background/Objectives: Considering the high consumption of coffee in Brazil, this study aimed to investigate the relationship between coffee consumption and the intake of added sugar, non-caloric sweeteners, sugary beverages, and foods. Methods: A modified case-crossover study was conducted using data from the national "Household Budget Survey (POF)" which 38,854 participants. Dietary intake was assessed using 24-h recalls on two non-consecutive days. Days with and without coffee consumption were compared (case-crossover) to evaluating the effects on sugar, sweeteners, sugary foods, sugar-sweetened beverages (SSB), and milk. Results: 87% of Brazilians aged 10 and older consumed coffee on a giving day. The consumption of all food groups decreased as days of coffee consumption increased, except for non-caloric sweeteners and sugar, which increased. In the case-crossover analysis (2192 men and 2580 women), women who consumed coffee on one of the two days showed an increase of 10 g of sugar and of 0.10 mL (2 drops) of sweeteners. For men values were 8 g and 0.05 mL. Also, women reduced sugar-sweetened beverages (-56.8 mL/day), while men reduced milk intake (-25.9 mL/day). Conclusions: Coffee consumption was associated with increased intake of sugar and non-caloric sweeteners and lower intake of sweets, SSB, and milk. Reducing sweets and SSB is beneficial but increasing sweeteners and reducing milk are not. Potential strategies include encouraging the use of milk in coffee instead of sugar and sweeteners, as well as reducing the size of sugar sachets, which in Brazil typically range from 5 g to 8 g.

Association between coffee consumption and metabolic syndrome in Korean adults

BACKGROUND/OBJECTIVES

Studies examining the association between coffee consumption and metabolic syndrome (MetS), considering different coffee types, have reported inconsistent results. We investigated the relationship between coffee consumption and MetS, taking into account coffee types, using data from the Korea National Health and Nutrition Examination Survey conducted from 2016 to 2021 among 14,631 adults aged 19-64 years.

SUBJECTS/METHODS

We used a 24-h dietary recall method to assess diet, including the type and quantity of coffee consumed. Coffee was categorized into black coffee and coffee with sugar and/or cream (non-drinkers, ≤1, 2-3, and >3 cups/day). Multivariable logistic regression models were utilized to investigate the relationship between coffee consumption and MetS, defined by the harmonized criteria.

RESULTS

After adjusting for potential covariates, for women, 2-3 cups/day of black coffee were inversely associated with MetS (OR = 0.66; 95% CI = 0.46-0.96). Three or fewer cups per day of black coffee were inversely associated with low high-density lipoprotein cholesterol (HDL-C) and elevated triglycerides in women. Coffee consumption was not significantly associated with MetS in men. Consumption of coffee with sugar and/or cream or more than three cups per day of coffee was not significantly associated with MetS overall.

CONCLUSION

Our findings suggest that moderate of 2-3 cups/day of black coffee consumption is inversely associated with MetS in women, possibly due to its favorable impact on HDL-C and triglycerides. Further prospective studies examining the consumption of different coffee types in relation to MetS are warranted to offer definitive evidence.

Associations between different coffee types, neurodegenerative diseases, and related mortality: findings from a large prospective cohort study

BACKGROUND

Observational studies have suggested associations between amount of coffee consumption and decreased risk of neurodegenerative diseases. However, these studies do not consider differences among coffee types, including sweetened, unsweetened, caffeinated, and decaffeinated varieties.

OBJECTIVES

This study aims to identify associations between the consumption of various coffee types (sugar-sweetened, artificially sweetened, unsweetened, caffeinated, and decaffeinated) and risks of Alzheimer's disease and related dementias (ADRD) and Parkinson's disease (PD), along with related mortality.

METHODS

This prospective study included 204,847 participants (44.7% males) from the UK Biobank. Cox proportional hazards models were used to assess the associations of coffee type with neurodegenerative outcome. On the basis of coffee consumption, participants were divided into 5 groups: non-coffee consumers, >0-1 cup/d, ≥1-2 cups/d, ≥2-3 cups/d, and ≥3 cups/d.

RESULTS

Over a median follow-up of 9 y, the study documented 1696 cases of ADRD, 1093 cases of PD, and 419 neurodegenerative-related deaths. In the multivariate analysis, compared with non-coffee consumers, those with the highest intake of unsweetened and caffeinated coffee (≥3 cups/d) showed hazard ratios (95% confidence intervals) of 0.75 (0.62, 0.91) for ADRD, 0.71 (0.56, 0.91) for PD, and 0.67 (0.44, 1.01) for neurodegenerative-related death. However, no significant associations were noted in either decaffeinated or sugar/artificially sweetened coffee groups (P > 0.05).

CONCLUSIONS

Higher intake of caffeinated coffee, particularly the unsweetened variety, was associated with reduced risks of ADRD and PD. No such associations were observed for sugar-sweetened or artificially sweetened coffee.

Turkish coffee has an antitumor effect on breast cancer cells in vitro and in vivo

BACKGROUND

Breast cancer is the most diagnosed cancer in women. Its pathogenesis includes several pathways in cancer proliferation, apoptosis, and metastasis. Some clinical data have indicated the association between coffee consumption and decreased cancer risk. However, little data is available on the effect of coffee on breast cancer cells in vitro and in vivo.

METHODS

In our study, we assessed the effect of Turkish coffee and Fridamycin-H on different pathways in breast cancer, including apoptosis, proliferation, and oxidative stress. A human breast cancer cell line (MCF-7) was treated for 48 h with either coffee extract (5% or 10 v/v) or Fridamycin-H (10 ng/ml). Ehrlich solid tumors were induced in mice for in vivo modeling of breast cancer. Mice with Ehrlich solid tumors were treated orally with coffee extract in drinking water at a final concentration (v/v) of either 3%, 5%, or 10% daily for 21 days. Protein expression levels of Caspase-8 were determined in both in vitro and in vivo models using ELISA assay. Moreover, P-glycoprotein and peroxisome proliferator-activated receptor gamma (PPAR-γ) protein expression levels were analyzed in the in vitro model. β-catenin protein expression was analyzed in tumor sections using immunohistochemical analysis. In addition, malondialdehyde (MDA) serum levels were analyzed using colorimetry.

RESULTS

Both coffee extract and Fridamycin-H significantly increased Caspase-8, P-glycoprotein, and PPAR-γ protein levels in MCF-7 cells. Consistently, all doses of in vivo coffee treatment induced a significant increase in Caspase-8 and necrotic zones and a significant decrease in β- catenin, MDA, tumor volume, tumor weight, and viable tumor cell density.

CONCLUSION

These findings suggest that coffee extract and Fridamycin-H warrant further exploration as potential therapies for breast cancer.

Association of coffee and tea consumption with osteoporosis risk: A prospective study from the UK biobank

OBJECTIVE

The association of coffee and tea consumption with osteoporosis is highly controversial, and few studies have focused on the combined effects of the two beverages. This study aimed to investigate the independent and combined associations of coffee and tea consumption with osteoporosis risk.

METHODS

A prospective cohort study involving 487,594 participants aged 38-73 years from the UK Biobank was conducted. Participants with reported coffee and tea consumption and without osteoporosis at baseline were included. Coffee and tea consumption were assessed via a touch-screen questionnaire at baseline. Newly diagnosed osteoporosis during the follow-up period, defined based on ICD-10 codes (M80-M82), was the primary outcome. Cox regression analyses were utilized to calculate hazard ratios (HRs) and 95 % confidence intervals (CIs). Dose-effect associations were assessed using restricted cubic spline analysis.

RESULTS

During a median follow-up of 12.8 years, 15,211 cases of osteoporosis were identified. Compared to individuals without coffee or tea consumption, drinking coffee was associated with an HR of 0.93 (95 % CI: 0.89-0.96), and tea consumption with an HR of 0.86 (95 % CI: 0.83-0.90). Continuous trends were significant for both coffee and tea consumption, showing non-linear associations with osteoporosis incidence. Moderate consumption, such as 1-2 cups of coffee or 3-4 cups of tea per day, was associated with a lower incidence of osteoporosis, with HRs of 0.9 (95 % CI: 0.86-0.94) and 0.85 (95 % CI: 0.81-0.90), respectively. Additionally, combined coffee and tea consumption displayed a U-shaped association with osteoporosis risk, with the lowest risk observed in individuals who consumed 1-2 cups of both beverages daily, with an HR of 0.68 (95 % CI: 0.61-0.75).

CONCLUSION

Our findings highlight the potential benefits of moderate coffee and tea consumption in reducing the risk of osteoporosis.

Artificially sweetened beverage consumption and all-cause and cause-specific mortality: an updated systematic review and dose-response meta-analysis of prospective cohort studies

BACKGROUND

Artificially sweetened beverages (ASB) are consumed globally, but their impact on overall health remains uncertain. We summarized published associations between ASB intake with all-cause and cause-specific mortality.

METHODS

We searched Medline, Embase, Web of Science, and Cochrane CENTRAL databases until August 2023. Random effect meta-analysis was conducted to calculate pooled risk ratios (RRs) and 95% confidence intervals (95%CIs) for highest versus lowest categories of ASB consumption in relation to all-cause and cause-specific mortality. Linear and non-linear dose-response analyses were also performed.

RESULTS

Our systematic review and meta-analysis included 11 prospective cohort studies. During a median/mean follow-up period of 7.0 to 28.9 years, 235,609 deaths occurred among 2,196,503 participants. Intake of ASB was associated with higher risk of all-cause and CVD mortality with pooled RRs (95%CIs) of highest vs. lowest intake categories of 1.13 (1.06, 1.21) (I2 = 66.3%) for all-cause mortality and 1.26 (1.10, 1.44) (I2 = 52.0%) for CVD mortality. Dose-response analysis revealed a non-linear association of ASB with all-cause mortality (pnon-linearity = 0.01), but a linear positive association with CVD mortality (pnon-linearity = 0.54). No significant association was observed for ASB intake and cancer mortality. Moreover, a secondary meta-analysis demonstrated that replacing 1 serving/day of sugary sweetened beverages (SSB) with ASB was associated with 4-6% lower risk of all-cause and CVD mortality. Per NutriGrade, the evidence quality for associations between ASB intake with all-cause and CVD mortality was moderate.

CONCLUSIONS

Higher intake of ASB was associated with higher risk of all-cause and CVD mortality, albeit a lower risk than for SSB.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022365701.

Is coffee, tea, and red wine consumption beneficial for individuals with hypertension?

OBJECTIVE

To investigate the associations of tea, coffee, and red wine intakes with health risks among individuals with hypertension.

METHODS

This prospective cohort study included participants with hypertension from the UK Biobank cohort. Study exposures included self-reported intakes of coffee, tea, and red wine. The primary outcome was all-cause mortality, and the secondary outcomes were cardiovascular mortality and cardiovascular disease. The associations of beverage intake with outcomes were analyzed using Cox regression models. The hazard ratios and 95% confidence intervals were estimated.

RESULTS

A total of 187 708 participants with hypertension were included. The median follow-up period was 13.8 years. In individuals with hypertension, drinking one to two cups/day of coffee or three to four cups/day of tea was significantly associated with the lowest risk of all-cause mortality compared with less than one cup/day [hazard ratio for coffee, 0.943 (95% confidence interval, 0.908-0.979); hazard ratio for tea, 0.882 (95% confidence interval, 0.841-0.924)]. Red wine intake was inversely associated with all-cause mortality risk. Dose-response analysis revealed that high coffee intake (approximately greater than or equal to six cups/day) was significantly associated with increased risks of cardiovascular mortality and cardiovascular disease, but high tea and red wine intakes were not. Furthermore, replacing plain water with tea, but not coffee, significantly reduced the risks of all-cause mortality and cardiovascular disease. Replacing other alcoholic beverages with red wine also significantly reduced the risks of all three outcomes.

CONCLUSIONS

These findings suggest that tea and red wine, but not coffee, can be part of a healthy diet for the hypertensive population.

Adherence to the EAT-Lancet diet and incident depression and anxiety

High-quality diets have been increasingly acknowledged as a promising candidate to counter the growing prevalence of mental health disorders. This study aims to investigate the prospective associations of adhering to the EAT-Lancet reference diet with incident depression, anxiety and their co-occurrence in 180,446 UK Biobank participants. Degrees of adherence to the EAT-Lancet diet were translated into three different diet scores. Over 11.62 years of follow-up, participants in the highest adherence group of the Knuppel EAT-Lancet index showed lower risks of depression (hazard ratio: 0.806, 95% CI: 0.730-0.890), anxiety (0.818, 0.751-0.892) and their co-occurrence (0.756, 0.624-0.914), compared to the lowest adherence group. The corresponding hazard ratios (95% CIs) were 0.711 (0.627-0.806), 0.765 (0.687-0.852) and 0.659 (0.516-0.841) for the Stubbendorff EAT-Lancet index, and 0.844 (0.768-0.928), 0.825 (0.759-0.896) and 0.818 (0.682-0.981) for the Kesse-Guyot EAT-Lancet diet index. Our findings suggest that higher adherence to the EAT-Lancet diet is associated with lower risks of incident depression, anxiety and their co-occurrence.

Coffee consumption was associated with a lower prevalence of airflow limitation in postmenopausal women

BACKGROUND

Several studies have suggested a potential correlation between menopause and airflow limitation. However, the presence of protective factors in postmenopausal women remains uncertain. Therefore, our study seeks to examine potential protective factors associated with a reduced prevalence of airflow limitation among postmenopausal women.

METHODS

Postmenopausal women were recruited from the Taiwan Biobank for this cross-sectional study. Airflow limitation was defined by a forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) ratio <0.7. The participants were categorized into two groups: non-coffee drinkers and coffee drinkers, and the association between coffee consumption and airflow limitation was examined using binary logistic regression models.

RESULTS

A total of 8149 women with available information were enrolled. Compared to the non-coffee drinkers, the coffee drinkers had a significantly lower prevalence of airflow limitation (7% vs. 5%). The odds ratio (OR) for airflow limitation was lower in the coffee drinkers than in the non-coffee drinkers (OR = 0.77; 95% confidence interval [CI] = 0.63 to 0.94) after adjusting for confounding factors. We also examined the association between daily coffee consumption in cups and airflow limitation. The women who consumed ≥2 cups of coffee per day had an OR of 0.74 (95% CI = 0.59 to 0.94) compared to those who did not consume coffee.

CONCLUSIONS

Our results suggest that habitual coffee consumption is associated with a reduction in the prevalence of airflow limitation in postmenopausal women, warranting further prospective studies to explore possible causal effects and mechanisms.

The causal association between artificial sweeteners and the risk of cancer: a Mendelian randomization study

Artificial sweeteners (ASs) have been widely added to food and beverages because of their properties of low calories and sweet taste. However, whether the consumption of ASs is causally associated with cancer risk is not clear. Here, we utilized the two-sample Mendelian randomization (MR) method to study the potential causal association. Genetic variants like single-nucleotide polymorphisms (SNPs) associated with exposure (AS consumption) were extracted from a genome-wide association study (GWAS) database including 64 949 Europeans and the influence of confounding was removed. The outcome was from 98 GWAS data and included several types of cancers like lung cancer, colorectal cancer, stomach cancer, breast cancer, and so on. The exposure-outcome SNPs were harmonized and then MR analysis was performed. The inverse-variance weighted (IVW) with random effects was used as the main analytical method accompanied by four complementary methods: MR Egger, weighted median, simple mode, and weighted mode. Sensitivity analyses consisted of heterogeneity, pleiotropy, and leave-one-out analysis. Our results demonstrated that ASs added to coffee had a positive association with high-grade and low-grade serous ovarian cancer; ASs added to tea had a positive association with oral cavity and pharyngeal cancers, but a negative association with malignant neoplasm of the bronchus and lungs. No other cancers had a genetic causal association with AS consumption. Our MR study revealed that AS consumption had no genetic causal association with major cancers. Larger MR studies or RCTs are needed to investigate small effects and support this conclusion.

Association of daily sitting time and coffee consumption with the risk of all-cause and cardiovascular disease mortality among US adults

BACKGROUND

Sedentary behavior has been demonstrated to be a modifiable factor for several chronic diseases, while coffee consumption is believed to be beneficial for health. However, the joint associations of daily sitting time and coffee consumption with mortality remains poorly understood. This study aimed to evaluate the independent and joint associations of daily sitting time and coffee intakes with mortality from all-cause and cardiovascular disease (CVD) among US adults.

METHODS

An analysis of a prospective cohort from the 2007-2018 National Health and Nutrition Examination Survey of US adults (n = 10,639). Data on mortality were compiled from interview and physical examination data until December 31, 2019. Daily sitting time was self-reported. Coffee beverages were from the 24-hour diet recall interview. The main outcomes of the study were all-cause and cardiovascular disease mortality. The adjusted hazard ratios [HRs] and 95% confidence intervals [CI] were imputed by Cox proportional hazards regression.

RESULTS

Among 10,639 participants in the study cohort, there were 945 deaths, 284 of whom died of CVD during the follow-up period of up to 13 years. Multivariable models showed that sitting more than 8 h/d was associated with higher risks of all-cause (HR, 1.46; 95% CI, 1.17-1.81) and CVD (HR, 1.79; 95% CI, 1.21-2.66) mortality, compared with those sitting for less than 4 h/d. People with the highest quartile of coffee consumption were observed for the reduced risks of both all-cause (HR, 0.67; 95% CI, 0.54-0.84) and CVD (HR, 0.46; 95% CI, 0.30-0.69) mortality compared with non-coffee consumers. Notably, joint analyses firstly showed that non-coffee drinkers who sat six hours or more per day were 1.58 (95% CI, 1.25-1.99) times more likely to die of all causes than coffee drinkers sitting for less than six hours per day, indicating that the association of sedentary with increased mortality was only observed among adults with no coffee consumption but not among those who had coffee intake.

CONCLUSIONS

This study identified that sedentary behavior for more than 6 h/d accompanied with non-coffee consumption, were strongly associated with the increased risk of mortality from all-cause and CVD.

Association of a Mediterranean Lifestyle With All-Cause and Cause-Specific Mortality: A Prospective Study from the UK Biobank

OBJECTIVE

To examine the association between the Mediterranean lifestyle and all-cause, cancer, and cardiovascular disease (CVD) mortality in a British population.

PATIENTS AND METHODS

We studied 110,799 individuals 40 to 75 years of age from the UK Biobank cohort, free of CVD or cancer between 2009 and 2012 who were followed-up to 2021. The Mediterranean lifestyle was assessed at baseline through the Mediterranean Lifestyle (MEDLIFE) index, derived from the lifestyle questionnaire and diet assessments and comprising three blocks: (1) "Mediterranean food consumption," (2) "Mediterranean dietary habits," and (3) "physical activity, rest, social habits, and conviviality." Death information was retrieved from death register records. Cox regression models were used to analyze the study associations.

RESULTS

During a median 9.4-year follow-up, 4247 total deaths, 2401 cancer deaths, and 731 CVD deaths were identified. Compared with the first quartile of the MEDLIFE index, increasing quartiles had HRs of 0.89 (95% CI, 0.81 to 0.97), 0.81 (95% CI, 0.74 to 0.89), and 0.71 (95% CI, 0.65 to 0.78) (P-trend<.001 for all-cause mortality). For cancer mortality, the quartiles had HRs of 0.90 (95% CI, 0.80 to 1.01), 0.83 (95% CI, 0.74 to 0.93), and 0.72 (95% CI, 0.64 to 0.82) (P-trend<.001). All MEDLIFE index blocks were independently associated with lower risk of all-cause and cancer death, and block 3 was associated with lower CVD mortality.

CONCLUSION

Higher adherence to the Mediterranean lifestyle was associated with lower all-cause and cancer mortality in British middle-aged and older adults in a dose-response manner. Adopting a Mediterranean lifestyle adapted to the local characteristics of non-Mediterranean populations may be possible and part of a healthy lifestyle.

Sweetened Beverages, Genetic Susceptibility, and Incident Atrial Fibrillation: A Prospective Cohort Study

BACKGROUND

An association between sweetened beverages and several cardiometabolic diseases has been reported, but their association with atrial fibrillation (AF) is unclear. We aimed to investigate the associations between consumption of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB), and pure fruit juice (PJ) and risk of consumption with AF risk and further evaluate whether genetic susceptibility modifies these associations.

METHODS

A total of 201 856 participants who were free of baseline AF, had genetic data available, and completed a 24-hour diet questionnaire were included. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

During a median follow-up of 9.9 years, 9362 incident AF cases were documented. Compared with nonconsumers, individuals who consumed >2 L/wk of SSB or ASB had an increased risk of AF (HR, 1.10 [95% CI, 1.01-1.20] and HR, 1.20 [95% CI, 1.10-1.31]) in the multivariable-adjusted model. A negative association was observed between the consumption of ≤1 L/wk of PJ and the risk of AF (HR, 0.92 [95% CI, 0.87-0.97]). The highest HRs (95% CIs) of AF were observed for participants at high genetic risk who consumed >2 L/wk of ASB (HR, 3.51 [95% CI, 2.94-4.19]), and the lowest HR were observed for those at low genetic risk who consumed ≤1 L/wk of PJ (HR, 0.77 [95% CI, 0.65-0.92]). No significant interactions were observed between the consumption of SSB, ASB, or PJ and genetic predisposition to AF.

CONCLUSIONS

Consumption of SSB and ASB at >2 L/wk was associated with an increased risk for AF. PJ consumption ≤1 L/wk was associated with a modestly lower risk for AF. The association between sweetened beverages and AF risk persisted after adjustment for genetic susceptibility to AF. This study does not demonstrate that consumption of SSB and ASB alters AF risk but rather that the consumption of SSB and ASB may predict AF risk beyond traditional risk factors.

Coffee, adenosine, and the liver

A variety of observational studies have demonstrated that coffee, likely acting through caffeine, improves health outcomes in patients with chronic liver disease. The primary pharmacologic role of caffeine is to act as an inhibitor of adenosine receptors. Because key liver cells express adenosine receptors linked to liver injury, regeneration, and fibrosis, it is plausible that the biological effects of coffee are explained by effects of caffeine on adenosinergic signaling in the liver. This review is designed to help the reader make sense of that hypothesis, highlighting key observations in the literature that support or dispute it.

Coffee consumption and risk of kidney function decline in a Dutch population-based cohort

BACKGROUND AND AIMS

Whether coffee consumption is associated with changes in estimated glomerular filtration rate (eGFR) is unknown. We investigated the relationship between coffee consumption and annual eGFR change in a large Dutch population-based study.

METHODS AND RESULTS

This study was performed in 78,346 participants without chronic kidney disease (CKD) in the population-based Lifelines Cohort Study. Coffee consumption was assessed at baseline using food frequency questionnaires. Outcomes were annual eGFR change and a composite kidney outcome (defined as eGFR <60 mL/min per 1.73 m2 or >20 % eGFR decline). Multivariable linear and logistic regression analyses were used to evaluate the associations of coffee consumption (categories and cups/day) with kidney outcomes. Overall, 90 % of the participants drank coffee daily and 36 % drank >2-4 cups/day. Unadjusted mean ± SD annual eGFR change ranged from -2.86 ± 2.96 (for non-coffee drinkers) to -2.35 ± 2.62 (for participants consuming >6 cups/day) mL/min per 1.73 m2. During 3.6 ± 0.9 years follow-up, 11.1 % of participants reached the composite kidney outcome. As compared to non-coffee drinkers, higher coffee consumption was associated with less annual eGFR decline in multivariable models (β [95 % CIs] ranged from 0.15 [0.07, 0.22] for >0-2 cups/day to 0.29 [0.20, 0.38] for >6 cups/day, P-trend <0.001). Consumption of one more cup of coffee per day was associated with a 3 % lower risk of the composite kidney outcome (OR [95%CI], 0.97 [0.96, 0.99]). The inverse association was more pronounced in a subgroup of individuals with diabetes.

CONCLUSION

Coffee consumption was inversely associated with annual eGFR change and CKD risk in a large Dutch population-based cohort.

Association of a healthy beverage score with total mortality in the adult population of Spain: A nationwide cohort study

BACKGROUND

Despite the substantial evidence of the relationship between diet and mortality, the role of beverage consumption patterns is not well known. The aim of this study was to assess the association of the adherence to a Healthy Beverage Score (HBS) and all-cause mortality in a representative sample of the Spanish adult population.

METHODS AND FINDINGS

We conducted an observational cohort study using data from the Study on Nutrition and Cardiovascular Risk in Spain (ENRICA), which included 12,161 community-dwelling individuals aged ≥18 years recruited in 2008 to 2010 and followed until January 2022. At baseline, food consumption was collected using a validated diet history. The HBS consists of 7 items, each of which is scored from 1 to 4 (highest adherence). The HBS ranges from 7 to 28 points with a higher score representing a healthier pattern. Adherence was assigned as a higher consumption of low-fat milk, and coffee and tea, a lower consumption of whole-fat milk, no consumption of fruit juice, artificially sweetened beverages, or sugar-sweetened beverages, and no or moderate consumption of alcohol. Total mortality was ascertained by linkage to the Spanish National Death Index. Statistical analyses were performed with Cox models and adjusted for the main confounders, including sociodemographic, lifestyle, dietary variables, and morbidity. After a mean follow-up of 12.5 years (SD: 1.7; range: 0.5 to 12.9), a total of 967 deaths occurred. For all-cause mortality, the fully adjusted hazard ratio (HR) for the highest versus lowest sex-specific quartiles of HBS was 0.72 (95% confidence interval [0.57, 0.91], p linear-trend = 0.015), corresponding to an 8.3% reduction in the absolute risk of death. A linear relationship between the risk of death and the adherence to the HBS was observed using restricted cubic splines. The results were robust to sensitivity analyses. The main limitation was that repeated measurements on beverage consumption were not available and beverage consumption could have changed during follow-up.

CONCLUSIONS

In this study, we observed that higher adherence to the HBS was associated with lower total mortality. Adherence to a healthy beverage pattern could play a role in the prevention of premature mortality.

Association between coffee consumption and high C-reactive protein levels in Korean adults

The findings of studies investigating the relationship between coffee consumption and C-reactive protein (CRP) levels have been inconsistent, and few researchers considered the type of coffee. We examined the association between coffee consumption and high CRP levels, using data from the Korea National Health and Nutrition Examination Survey, 2016-2018, with 9337 adults aged 19-64 years. A 24-h diet recall was used to assess diet, including the amount and type of coffee consumed. We classified coffee into black coffee and coffee with sugar and/or cream (non-drinkers, or ≤ 1, 2-3, > 3 cups/d) and used multivariable logistic regression models with high CRP levels (≥ 2·2 mg/l). After the adjustment for potential confounders, 2-3 cups/d of coffee consumption were inversely associated with high CRP levels, compared with no consumption (OR = 0·83, 95 % CI 0·69, 0·99). By type of coffee, the inverse association was stronger in subjects consuming black coffee (OR = 0·61, 95 % CI 0·45, 0·84), while the inverse association was much weaker in those consuming coffee with sugar and/or cream (OR = 0·92, 95 % CI 0·74, 1·14). By sex, the inverse association of 2-3 cups of black coffee was found both in men (OR = 0·65, 95 % CI 0·41, 1·03) and women (OR = 0·55, 95 % CI 0·36, 0·83). More than three cups/d of heavy coffee consumption were not significantly associated with high CRP levels. Our findings indicate that moderate black coffee consumption of 2-3 cups/d is inversely associated with high CRP levels in Korean adults. Further prospective studies are warranted to provide definitive evidence.

Cholecystectomy is associated with a higher risk of irritable bowel syndrome in the UK Biobank: a prospective cohort study

Background: Recent studies have shown that bile acids are essential in irritable bowel syndrome (IBS) pathology, and cholecystectomy has direct effects on bile acid metabolism. However, whether cholecystectomy increases the risk of IBS remains unclear. We aimed to investigate the association between cholecystectomy and IBS risk in the UK Biobank (UKB). Methods: This study is a prospective analysis of 413,472 participants who were free of IBS, inflammatory bowel disease, cancer, or common benign digestive tract diseases. We identified incidents of IBS through self-reporting or links to primary healthcare and hospitalization data. We evaluated hazard ratios (HRs) adjusted for sociodemographic characteristics, health behaviours, comorbidities, and medications. Results: During a median follow-up period of 12.7 years, we observed 15,503 new cases of IBS. Participants with a history of cholecystectomy had a 46% higher risk of IBS than those without (HR = 1.46, 95% CI: 1.32-1.60), and further subtype analysis showed that the risk of IBS with diarrhoea was significantly higher than the risk of IBS without diarrhoea (HR = 1.71, 95% CI: 1.30-2.25 vs. HR = 1.42, 95% CI: 1.28-1.58). The overall covariate-adjusted HRs for IBS were similar between the group with both cholecystectomy and gallstones (HR = 1.45, 95% CI: 1.32-1.58) and the group with cholecystectomy without gallstones (HR = 1.50, 95% CI: 1.36-1.67) when the group without both cholecystectomy and gallstones was used as a reference. The overall covariate-adjusted HR was not significantly different in the group without cholecystectomy with gallstones (HR = 1.18, 95% CI: 0.95-1.47). The positive association of cholecystectomy with IBS risk did not change when stratifying the data based on age, sex, BMI, smoking, alcohol consumption, healthy diet, quality sleep, physical activity, type 2 diabetes, hypertension, hyperlipidaemia, mental illness, NSAID intake, or acid inhibitor intake. Sensitivity analyses, including propensity score matching analysis and lagging the exposure for two or four years, indicated that the effects were robust. Conclusion: Cholecystectomy was associated with a higher risk of IBS, especially IBS with diarrhoea. Additional prospective randomized controlled and experimental studies are warranted to further validate the association and to explore the relevant biological mechanisms.

Changes in Coffee Intake, Added Sugar and Long-Term Weight Gain - Results from Three Large Prospective US Cohort Studies

BACKGROUND

Consumption of both caffeinated and decaffeinated coffee has been reported to attenuate long-term weight gain. Whether the association between coffee consumption and weight gain depends on the addition of sugar, cream, or coffee whitener remains unclear.

OBJECTIVE

We aimed to study the associations between changes in coffee consumption, caffeine intake, and weight changes by considering the addition of sugar, cream, or a nondairy coffee whitener.

METHODS

We used 3 large prospective cohorts - the Nurses' Health Study (1986 - 2010), Nurses' Health Study II (1991 - 2015) and Health Professional Follow-up Study (1991 - 2014). We applied multivariable linear regression models with robust variance estimators to assess the association of changes in coffee habits within each 4-y interval with concurrent weight changes. Results across the 3 cohorts were pooled using inverse-variance weights.

RESULTS

After multivariable adjustment, each 1 cup per day increment in unsweetened caffeinated coffee was associated with a reduction in 4-y weight gain of -0.12 kg (95 % CI: -0.18, -0.05 kg) and of -0.12 kg (95 % CI: -0.16, -0.08 kg) for unsweetened decaffeinated coffee. The habits of adding cream or nondairy coffee whitener were not significantly linked to weight changes. Adding a teaspoon of sugar was associated with a 4-y weight gain of +0.09 kg (0.07, 0.12 kg). Stratified analyses suggested stronger magnitude of the observed associations with younger age and higher baseline BMI. Neither caffeine nor coffee modified the association of adding sugar to any food or beverage with weight changes.

CONCLUSIONS

An increase in intake of unsweetened caffeinated and decaffeinated coffee was inversely associated with weight gain. The addition of sugar to coffee counteracted coffee's benefit for possible weight management. To the contrary, adding cream or coffee whitener was not associated with greater weight gain.

U-shaped association between sleep duration and the risk of respiratory diseases mortality: a large prospective cohort study from UK Biobank

STUDY OBJECTIVES

Our cohort study aimed to study the association between sleep duration and risk of mortality due to respiratory diseases.

METHODS

We included 498,200 participants from UK Biobank (2006-2021). We classified sleep duration as short sleep duration (< 7 hours), long sleep duration (> 9 hours for adults, > 8 hours for older adults), and midrange sleep duration (7-9 hours). We used the Cox proportional hazards model and restricted cubic spline analysis to explore the association between sleep duration and respiratory diseases mortality.

RESULTS

During a median follow-up of 12.49 years, 2,477 deaths due to respiratory diseases were recorded, of which 1,099 were deaths due to chronic lower respiratory diseases. Cox models with penalized splines showed U-shaped associations of sleep duration with mortality due to total respiratory diseases and chronic lower respiratory diseases. Compared with midrange sleep duration, short sleep duration was associated with 14% higher risk of total respiratory diseases mortality (hazard ratio = 1.14; 95% confidence interval: 1.04, 1.25), and long sleep duration was associated with 35% higher risk of total respiratory diseases mortality (hazard ratio = 1.35; 95% confidence interval: 1.19, 1.55), after adjustment of baseline characteristics, health status, and lifestyle habits. Similarly, the hazard ratios for chronic lower respiratory diseases mortality were 1.20 (95% confidence interval: 1.04, 1.38) and 1.44 (95% confidence interval: 1.19, 1.74), respectively.

CONCLUSIONS

There was a U-shaped association between sleep duration and respiratory diseases mortality. Appropriate sleep duration may improve the progress of respiratory diseases.

CITATION

Du M, Liu M, Liu J. U-shaped association between sleep duration and the risk of respiratory diseases mortality: a large prospective cohort study from UK Biobank. J Clin Sleep Med. 2023;19(11):1923-1932.

Intake of sugary beverages with chronic conditions and multimorbidity: a prospective cohort study of UK Biobank

BACKGROUND

The burden of chronic conditions associated with sugary beverages is increasing but little is known about the role of different types of sugary beverages in the co-occurrence of multiple chronic conditions ('multimorbidity'). To inform future sugar-reduction guidelines, we aimed to examine the associations of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB) and natural juices (NJ) with multimorbidity.

METHODS

This prospective cohort study included 184 093 UK Biobank participants aged 40-69 years at baseline who completed at least one occasion of 24-h dietary recall between 2009 and 2012. Daily consumptions of SSB, ASB and NJ were assessed using 24-h dietary recall. Participants were followed from the first 24-h assessment until the onset of two or more new chronic conditions, or the end of follow-up (31 March 2017), whichever occurred first. Logistic regression models, Cox proportional hazard models and quasi-Poisson mixed effects models were used to estimate the association of beverages intakes with chronic conditions and multimorbidity.

RESULTS

A total of 19 057 participants had multimorbidity at baseline and 19 968 participants developed at least two chronic conditions during follow-up. We observed dose-response relationships of SSB and ASB consumptions with the prevalence and incidence of multimorbidity. For example, the adjusted hazard ratios (HRs) and 95% CIs of the incidence of developing at least two chronic conditions ranged from 1.08 (1.01-1.14) for SSB intake of 1.1-2 units/day to 1.23 (1.14-1.32) for >2 units/day compared with 0 units/day. Also, the adjusted HRs (95% CIs) of ASB consumption ranged from 1.08 (1.03-1.13) for 0.1-1 unit/day to 1.28 (1.17-1.40) for >2 units/day compared with non-consumers. Conversely, moderate consumption of NJ was associated with a smaller risk of the prevalence and incidence of multimorbidity. Moreover, higher intakes of SSB and ASB were positively associated whereas moderate intake of NJ was inversely associated with increased number of new-onset chronic conditions during follow-up.

CONCLUSIONS

Higher SSB and ASB intakes were positively associated whereas moderate NJ intake was inversely associated with the higher risk of multimorbidity and increased number of chronic conditions. Current and intended policy options to decrease the burden of chronic conditions and multimorbidity need a formulation of SSB and ASB reduction strategies.

Coffee and tea intake with long-term risk of irritable bowel syndrome: a large-scale prospective cohort study

BACKGROUND

To investigate prospective association of coffee and tea intake with incident irritable bowel syndrome (IBS) in a long-term cohort.

METHODS

Participants free of IBS, coeliac disease, inflammatory bowel disease and any cancer at baseline from UK Biobank were included. Coffee and tea intake was measured separately via baseline touchscreen questionnaire, with four categories for each intake (0, 0.5-1, 2-3 and ≥4 cups/day). Primary outcome was incident IBS. Cox proportional hazard model was used to estimate associated risk.

RESULTS

Among 425 387 participants, 83 955(19.7%) and 186 887(43.9%) consumed ≥4 cups/day of coffee and tea at baseline, respectively. During median 12.4-year follow-up, incident IBS was identified in 7736 participants. Compared with no coffee intake, consumption of 0.5-1, 2-3 and ≥4 cups/day was associated with lower IBS risk [hazard ratio (HR)=0.93, 95% CI: 0.87-0.99; 0.91, 0.85-0.97; 0.81, 0.76-0.88; Ptrend < 0.001]. Specifically, decreased risk was evident in individuals who consumed instant (HR = 0.83, 0.78-0.88) or ground coffee (HR = 0.82, 0.76-0.88) compared with no coffee drink. Regarding tea intake, protective association was only found in individuals who consumed 0.5-1 cup/day (HR = 0.87, 0.80-0.95), whereas no significant association was detected in those who consumed 2-3 (HR = 0.94, 0.88-1.01) or ≥4 cups/day (HR = 0.95, 0.89-1.02) compared with no-tea intake (Ptrend = 0.848).

CONCLUSIONS

Higher intake of coffee, particularly instant and ground coffee, is associated with lower risk of incident IBS, with significant dose-response relationship. Moderate-tea intake (0.5-1 cup/day) is associated with lower IBS risk.

Association of medicinal plant consumption with all-cause mortality and cognitive impairment in older adult: A large prospective cohort study

BACKGROUND

Panax ginseng and other medicinal plants have long been believed to have beneficial effects on health, and there is substantial evidence supporting their mechanisms of action. However, the extent of the health benefits derived from consuming these medicinal plants lacks substantial evidence from large-scale longitudinal population studies. The purpose of this study was to analyze the effect of consuming these medicinal plants on all-cause mortality and cognitive impairment.

METHODS

A population-based cohort study was conducted using the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which was established in 1998 and has been followed up till now. The main exposure was the frequency of eating medicinal plants, including Panax ginseng, Astragalus membranaceus, Lycium barbarum, Angelica sinensis, etc. According to the consumption patterns of medicinal plants, the participants were divided into three groups: frequent use, occasional use, and rarely or never use group. The participants were individually tracked to determine their mortality and cognitive impairment status during the period from 2008 to 2018. Cox proportional hazards regression and competing risk model were used to calculate the hazard ratio (HR) for the association between the use of medicinal plants and the all-cause mortality and cognitive impairment.

RESULTS

Among 13,918 participants, the average age was 87.2 ± 11.3 years old, and 70.1% (9,754/13,918) of the participants died during follow-up. The proportion of those frequently using, occasionally using, and rarely using medicinal plants was 8.4%, 20.7%, and 70.8%, respectively. Compared with the rarely or never use group, the occasional and frequent use groups demonstrated significantly lower risks for all-cause mortality, with HR of 0.75 (95% CI: 0.71 - 0.79) and 0.53 (95% CI: 0.49 - 0.58), respectively. The protective effect of medicinal plants against all-cause mortality decreased with increasing age in the subgroup analysis. Additionally, frequent use of medicinal plants reduced the risk of cognitive impairment in the competing risk model (HR = 0.73, 95% CI: 0.60 - 0.87). However, there was no protective effect on cognitive function for those who occasional use medicinal plants.

CONCLUSION

In elderly individuals, occasional and frequent use of medicinal plants was associated with reductions in risk of all-cause mortality, and frequent use of medicinal plants could reduce the risk of cognitive impairment.

Associations of artificially sweetened beverages, sugar-sweetened beverages, and pure fruit/vegetable juice with visceral adipose tissue mass

OBJECTIVE

To test the associations of sugar-sweetened beverage, artificially sweetened beverage, and pure fruit/vegetable juice consumption with visceral adipose tissue (VAT) mass at baseline and follow-up and to determine whether BMI and genetic risk of VAT mass modified the associations.

METHODS

A total of 203,348 participants from UK Biobank with consumption data on three beverages were included. Participants were categorized into nonconsumers and consumers with >0-1, >1-2 and >2 L/week. A sex-specific prediction model was used to calculate VAT mass. A weighted genetic risk score for high VAT mass was calculated.

RESULTS

The participants with a sugar-sweetened beverage and artificially sweetened beverage consumption of >2 L/week had the greatest B values [B (95% CI): 24.02 (16.53, 31.51) and 60.81 (52.08, 69.54) in men, respectively; 10.20 (5.92, 14.48) and 24.72 (20.80, 28.64) in women]. Low and moderate intake of pure fruit/vegetable juices showed a significantly inverse association with VAT mass in men [-10.52 (-15.37, -5.67); -6.46 (-11.27, -1.65)] and women [-6.70 (-8.99, -4.41); -5.93 (-8.33, -3.54)]. Regarding changes in VAT mass, participants who consumed >2 L/week of sugar-sweetened beverages and artificially sweetened beverages had greater changes. BMI but not genetic risk modified the associations between beverage intake and VAT mass, which were strengthened in participants with BMI ≥25 kg/m2 for sugar-sweetened and artificially sweetened beverage consumption.

CONCLUSIONS

Higher consumption of sugar-sweetened beverages or artificially sweetened beverages was associated with greater VAT mass regardless of genetic risk. Mild-to-moderate intake of pure fruit/vegetable juices was linked to lower VAT mass.

Coffee consumption and periodontitis: a Mendelian Randomization study

BACKGROUND

Coffee is one of the most consumed beverages in the world, coffee consumption has been growing in the United States over the past 20 years. Periodontitis is defined by the pathologic loss of the periodontal ligament and destruction of the connective tissue attachment and alveolar bone loss and is related to different systemic diseases and conditions. However, the causality has remained unclarified, thus we regarded discovering the causal relationship between coffee consumption and the liability to periodontitis as the objective of the study.

METHODS

Coffee consumption was subdivided into binary coffee consumption and continuous coffee consumption to refine the study design. Genetic instruments were stretched from the MRC-IEU's (MRC Integrative Epidemiology Unit) output from the GWAS pipeline using phesant-derived variables based on the UK Biobank, the Gene-Lifestyle Interactions in Dental Endpoints (GLIDE) project, and the joint meta-analysis of a recent GWAS. The IVW (Inverse Variance Weighted) was regarded as the primary method to estimate the causality, a scatter plot revealed the intuitive result, and tests for stability were also carried out.

RESULTS

An effect of continuous coffee consumption on the risk of periodontitis was found, with per SD of coffee consumed increases, the risk of periodontitis rises by 1.04% (Odds Ratio of IVW is 1.0104), while the effect of binary coffee consumption on periodontitis did not meet the requirement of indicating a strong causal association, neither were the reverse causality analyses.

CONCLUSIONS

The study indicated the causality of continuous coffee consumption to the risk of periodontitis with a relatively small scale of effect estimate and no strong evidence for an effect of binary coffee-consuming behavior on periodontitis. There was also no intensive evidence suggesting reverse causality.

Coffee Consumption and Incidence of Cardiovascular and Microvascular Diseases in Never-Smoking Adults with Type 2 Diabetes Mellitus

The relationship between coffee consumption and diabetes-related vascular complications remains unclear. To eliminate confounding by smoking, this study assessed the relationships of coffee consumption with major cardiovascular disease (CVD) and microvascular disease (MVD) in never-smokers with type 2 diabetes mellitus (T2DM). Included were 9964 never-smokers with T2DM from the UK Biobank without known CVD or cancer at baseline (7781 were free of MVD). Participants were categorized into four groups according to daily coffee consumption (0, 0.5-1, 2-4, ≥5 cups/day). CVD included coronary heart disease (CHD), myocardial infarction (MI), stroke, and heart failure (HF). MVD included retinopathy, peripheral neuropathy, and chronic kidney disease (CKD). Cox regression models were used to estimate hazard ratios (HRs) and 95% confidential intervals (CIs) of total CVD and MVD and the component outcomes associated with coffee consumption. During a median of 12.7 years of follow-up, 1860 cases of CVD and 1403 cases of MVD were identified. Coffee intake was nonlinearly and inversely associated with CVD (P-nonlinearity = 0.023) and the component outcomes. Compared with no coffee intake, HRs (95% CIs) associated with a coffee intake of 2 to 4 cups/day were 0.82 (0.73, 0.93) for CVD, 0.84 (0.73, 0.97) for CHD, 0.73 (0.57, 0.92) for MI, 0.76 (0.57, 1.02) for stroke, and 0.68 (0.55, 0.85) for HF. Higher coffee intake (≥5 cups/day) was not significantly associated with CVD outcomes. Coffee intake was linearly and inversely associated with risk of CKD (HR for ≥5 vs. 0 cups/day = 0.64; 95% CI: 0.45, 0.91; P-trend = 0.0029) but was not associated with retinopathy or peripheral neuropathy. Among never-smoking individuals with T2DM, moderate coffee consumption (2-4 cups/day) was associated with a lower risk of various CVD outcomes and CKD, with no adverse associations for higher consumption.

Associations of Sugar-Sweetened Beverages, Artificially Sweetened Beverages, and Pure Fruit Juice With Nonalcoholic Fatty Liver Disease: Cross-sectional and Longitudinal Study

OBJECTIVE

We aimed to test the associations of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB), and pure fruit juice (PJ) consumption with the risk of nonalcoholic fatty liver disease (NAFLD).

METHODS

Data for 136 277 UK Biobank participants who completed the dietary questionnaire and did not have a history of liver disease were included. Logistic regression was used for the cross-sectional setting where NAFLD was defined by a fatty liver index (FLI) ≥60. Cox proportional hazard regression was used for the longitudinal setting where hospitalized NAFLD was defined as hospital admission with Internationl Classification of Diseases-10 codes K76.0 and K75.8.

RESULTS

Compared with 0 L/wk for corresponding beverages, multivariate-adjusted odds ratios (95% confidence intervals) for NAFLD in consumption ≤1, 1 to 2, and >2 L/wk were 1.06 (1.02-1.10), 1.24 (1.19-1.29), and 1.42 (1.35-1.49) for SSB; 1.43 (1.37-1.50), 1.73 (1.65-1.82), and 2.37 (2.25-2.50) for ASB, and 0.87 (0.84-0.89), 0.91 (0.88-0.94), and 1.07 (1.02-1.13) for PJ, respectively. Consumption of SSB and ASB were both positively correlated with FLI (P for line < .001). During a median follow-up of 10.2 years, 1043 cases of hospitalized NAFLD were recorded. ASB consumption of 1 to 2 and >2 L/wk was associated with a 22% (0.99-1.50) and 35% (1.11-1.65) increased risk of hospitalized NAFLD, respectively (P for trend = .002). However, the associations of SSB and PJ with the risk of hospitalized NAFLD were not significant.

CONCLUSIONS

Consumption of SSB, ASB, and PJ were all related to the risk of NAFLD. Excessive consumption of ASBs was associated with an increased risk of incident hospitalized NAFLD.