Professional Documents
Culture Documents
INTRODUCTION
cognitive function, and increased the heart rate (4). However, the
effect of coffee consumption on chronic disease risk is still being
debated. In randomized controlled trials it was observed that acute
coffee ingestion caused an increase in blood pressure (5, 6) and led
to an elevation in plasma concentrations of total and LDL cholesterol and homocysteine (79). Case-control studies reported
a positive association (3, 10, 11), or a J-shaped relation (12), between coffee consumption and the risk of CVD4. Moreover, some
studies reported an acute elevation in the risk of MI and stroke in
the hour of coffee ingestion (13, 14). These findings contributed to
the belief that coffee is harmful (15), which is widespread among
the general public and is also supported by current dietary recommendations that favor low to moderate coffee consumption.
Prospective cohort studies, however, reported conflicting results:
some studies suggested a positive association between coffee consumption and risk of CVD (16, 17), whereas others reported no
association (18, 19) or even an inverse association (2022). Most
previous studies focused on the risk of coronary heart disease, and
studies addressing stroke risk are even fewer. An inverse association between coffee consumption and risk of T2D has been suggested in a recent case-control study in the United States (23) and
in many prospective cohort studies in Europe (2426), the United
States (27, 28), and Japan (29). Studies investigating the association between coffee consumption and total cancer risk are rarely
found in the literature because most studies focused on site-specific
cancers. Some evidence exists that coffee may reduce the risk of
liver, breast, and oral cavity/pharynx cancers (3033). In contrast,
1
Am J Clin Nutr 2012;95:9018. Printed in USA. 2012 American Society for Nutrition
901
Supplemental Material can be found at:
http://ajcn.nutrition.org/content/suppl/2012/03/22/95.4.901.D
C1.html
ABSTRACT
Background: Early studies suggested that coffee consumption may
increase the risk of chronic disease.
Objective: We investigated prospectively the association between
coffee consumption and the risk of chronic diseases, including type
2 diabetes (T2D), myocardial infarction (MI), stroke, and cancer.
Design: We used data from 42,659 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC)Germany
study. Coffee consumption was assessed by self-administered foodfrequency questionnaire at baseline, and data on medically verified
incident chronic diseases were collected by active and passive followup procedures. HRs and 95% CIs were calculated with multivariate
Cox regression models and compared by competing risk analysis.
Results: During 8.9 y of follow-up, we observed 1432 cases of
T2D, 394 of MI, 310 of stroke, and 1801 of cancer as first qualifying events. Caffeinated (HR: 0.94; 95% CI: 0.84, 1.05) or decaffeinated (HR: 1.05; 95% CI: 0.84, 1.31) coffee consumption (4
cups/d compared with ,1 cup/d; 1 cup was defined as 150 mL) was
not associated with the overall risk of chronic disease. A lower risk
of T2D was associated with caffeinated (HR: 0.77; 95% CI: 0.63,
0.94; P-trend 0.009) and decaffeinated (HR: 0.70; 95% CI: 0.46,
1.06; P-trend: 0.043) coffee consumption (4 cups/d compared with
,1 cup/d), but cardiovascular disease and cancer risk were not. The
competing risk analysis showed no significant differences between
the risk associations of individual diseases.
Conclusion: Our findings suggest that coffee consumption does not
increase the risk of chronic disease, but it may be linked to a lower
risk of T2D.
Am J Clin Nutr 2012;95:9018.
902
FLOEGEL ET AL
Study population
The EPIC study is a multicenter prospective cohort study in 10
European countries that aims to investigate the associations between diet, lifestyle, and chronic disease risk. In Germany, there
are 2 study centers, which are located in Potsdam and Heidelberg.
Adults aged mainly between 35 and 65 y were recruited from the
general population in Potsdam, Heidelberg, and surrounding areas
with response rates of 22.7% in Potsdam and 38.3% in Heidelberg
(37, 38). A total of 53,088 adults (30,255 women and 22,833 men)
consented to participate during the recruitment examination, which
took place between 1994 and 1998. At baseline, study participants
underwent an examination that included anthropometric and blood
pressure measurements and an interview on medical history, including prevalent diseases. A self-administered questionnaire on
sociodemographic and lifestyle factors and an FFQ were also completed. After baseline, follow-up questionnaires were administered
every 23 y to identify incident cases of chronic diseases, including
T2D, MI, stroke, and cancer. For the current analysis, we considered the data until the fourth follow-up period. Written informed
consent was obtained from all study participants a priori. The study
was approved by the ethics committees of the Medical Society of
the State of Brandenburg and of the faculty of Medicine, Heidelberg University.
For the current analysis, we excluded participants with missing
information on coffee consumption (n = 17), those with selfreported chronic diseases (T2D, MI, stroke, or cancer) at baseline
(n = 5536) or with unknown disease status (n = 2392), those with
missing information on lifestyle factors and other covariates (n =
1830), and those who never completed a follow-up questionnaire
(n = 654).
Coffee consumption
The EPIC-Germany participants were inquired about their
habitual consumption of caffeinated coffee and decaffeinated
coffee in the self-administered semi-quantitative FFQ at baseline.
In particular, the 2 items were as follows: How frequently did you
903
TABLE 1
Baseline characteristics of the EPIC-Germany population (n = 42,659) according to caffeinated coffee consumption1
Caffeinated coffee consumption
No. of subjects
Women (%)2
Age (y)2
BMI (kg/m2)
Waist circumference (cm)
Waist-to-hip ratio
Currently employed (%)
University degree (%)
Current smokers (%)
Cigarettes smoked (no./d)3
Former smokers (%)
Sports (h/wk)
Watching television (h/wk)
Total energy intake (kcal/d)
Alcohol intake from beverages (g/d)
Decaffeinated coffee (cups/d)
Caffeinated tea (cups/d)
Taking vitamin supplement (%)
Taking mineral supplement (%)
Prevalent hypertension (%)
Systolic blood pressure (mm Hg)4
Diastolic blood pressure (mm Hg)4
,1 cup/d
1 to ,2 cups/d
2 to ,3 cups/d
3 to ,4 cups/d
4 cups/d
8689
56.1
49.9 6 8.6
25.8 6 0.04
86.4 6 0.11
0.86 6 0.00
69.0
34.6
14.4
13.2 6 0.3
32.2
3.8 6 0.0
12.3 6 0.1
2005 6 7
13.5 6 0.2
0.75 6 0.01
1.8 6 0.0
22.1
16.6
37.6
133.4 6 0.3
85.5 6 0.2
3860
58.9
49.2 6 8.5
25.8 6 0.06
86.0 6 0.17
0.85 6 0.00
74.3
36.9
14.9
11.7 6 0.4
33.3
3.4 6 0.1
12.4 6 0.1
1970 6 11
15.3 6 0.3
0.27 6 0.02
1.1 6 0.0
20.3
15.5
38.5
134.9 6 0.4
87.1 6 0.3
10,617
62.8
49.8 6 8.7
25.8 6 0.04
85.8 6 0.10
0.85 6 0.00
73.3
36.0
16.8
12.0 6 0.2
34.7
3.4 6 0.0
12.8 6 0.1
2001 6 6
15.9 6 0.2
0.15 6 0.01
0.73 6 0.02
18.8
13.4
38.2
136.0 6 0.2
87.6 6 0.2
7356
57.4
49.0 6 8.2
25.8 6 0.05
85.8 6 0.12
0.85 6 0.00
77.8
36.1
26.8
13.8 6 0.2
33.2
3.2 6 0.0
12.7 6 0.1
2045 6 8
16.8 6 0.2
0.10 6 0.01
0.54 6 0.01
19.5
14.4
35.4
134.3 6 0.3
86.8 6 0.2
12,137
56.9
50.2 6 8.4
26.2 6 0.04
86.8 6 0.09
0.85 6 0.00
73.2
33.0
30.2
15.7 6 0.2
31.0
3.2 6 0.0
13.5 6 0.1
2177 6 6
16.0 6 0.2
0.15 6 0.01
0.55 6 0.01
18.8
13.7
34.9
134.5 6 0.2
86.8 6 0.1
All values are age- and sex-adjusted means 6 SEs or percentages across coffee consumption categories, except where otherwise noted. One cup was
defined as 150 mL. EPIC, European Prospective Investigation into Cancer and Nutrition.
2
Unadjusted means 6 SDs or percentages.
3
In current smokers only.
4
n = 18,372.
1
(yes or no), vitamin and mineral supplement use (during past 4 wk:
yes or no), total energy intake (kcal/d), and tea intake (cups/d).
Model 3 included the covariates of model 2 with additional adjustment for risk factors that could be considered intermediates,
particularly BMI (in kg/m2), waist-to-hip ratio (continuous), and
prevalent hypertension (at least one of the following: systolic blood
pressure 140 mmHg, diastolic blood pressure 90 mmHg, blood
pressurelowering medication, or self-reported: yes or no). In addition, in models 2 and 3, caffeinated and decaffeinated coffee
consumption (cups/d) was mutually adjusted. We also calculated
continuous models because a dose-dependent effect was assumed.
Furthermore, the significance of linear trends across the caffeinated
coffee consumption categories was tested by assigning each participant the median of the category and modeling this value as
a continuous variable. In addition, we conducted a competing risk
analysis for Cox regression based on multivariate model 3 and
used the likelihood ratio test to compare the disease-specific risk
associations (42, 43).
Interactions were tested between coffee consumption (continuous), chronic disease risk, and the covariates age, sex, center
(Potsdam or Heidelberg), alcohol intake (categorical), smoking
status (categorical), BMI (30, yes or no), and hypertension (yes
or no). Models with and without multiplicative interaction terms
were compared by using the likelihood ratio test. If an interaction
was observed, a stratified analysis was conducted. For sensitivity
analysis, we calculated disease-specific HRs, including subjects
with any prevalent chronic disease, except the disease under investigation. Furthermore, we conducted the analysis excluding all
nonconsumers of coffee from the reference group, excluding tea
904
FLOEGEL ET AL
TABLE 2
Baseline characteristics of the EPIC-Germany population (n = 42,659) according to decaffeinated coffee consumption1
Decaffeinated coffee consumption
No. of subjects
Women (%)2
Age (y)2
BMI (kg/m2)
Waist circumference (cm)
Waist-to-hip ratio
Currently employed (%)
University degree (%)
Current smokers (%)
Cigarettes smoked (no./d)3
Former smokers (%)
Sports (h/wk)
Watching television (h/wk)
Total energy intake (kcal/d)
Alcohol intake from beverages (g/d)
Caffeinated coffee (cups/d)
Caffeinated tea (cups/d)
Taking vitamin supplement (%)
Taking mineral supplement (%)
Prevalent hypertension (%)
Systolic blood pressure (mm Hg)4
Diastolic blood pressure (mm Hg)4
,1 cup/d
1 to ,2 cups/d
2 to ,3 cups/d
3 to ,4 cups/d
4 cups/d
38,628
58.0
49.6 6 8.5
25.9 6 0.0
86.0 6 0.1
0.85 6 0.00
74.0
36.2
21.5
13.9 6 0.1
32.8
3.3 6 0.0
12.8 6 0.0
2055 6 3
15.7 6 0.1
2.9 6 0.0
0.91 6 0.01
19.6
14.5
36.3
134.7 6 0.1
86.8 6 0.1
1273
62.9
50.3 6 8.6
26.2 6 0.1
86.6 6 0.3
0.85 6 0.00
69.0
25.6
19.1
14.2 6 0.6
32.0
3.7 6 0.1
13.0 6 0.2
2056 6 19
12.9 6 0.5
1.6 6 0.1
0.67 6 0.05
21.8
15.6
39.0
133.8 6 0.7
85.8 6 0.4
1390
64.5
51.6 6 8.6
26.8 6 0.1
88.3 6 0.3
0.86 6 0.00
65.0
24.0
19.0
14.1 6 0.6
33.4
3.7 6 0.1
13.6 6 0.2
2026 6 18
13.8 6 0.5
1.3 6 0.1
0.60 6 0.05
20.8
13.8
42.6
136.3 6 0.7
87.2 6 0.4
486
60.5
51.1 6 8.3
26.8 6 0.2
88.8 6 0.5
0.87 6 0.00
71.0
25.6
28.2
14.6 6 0.9
31.7
3.7 6 0.1
13.9 6 0.4
2038 6 30
15.2 6 0.9
1.1 6 0.1
0.65 6 0.08
21.1
17.1
40.0
133.5 6 1.1
85.3 6 0.7
882
59.9
50.6 6 8.2
27.4 6 0.1
89.6 6 0.3
0.87 6 0.00
67.0
15.7
35.6
17.0 6 0.6
32.3
3.8 6 0.1
15.1 6 0.3
2178 6 22
14.2 6 0.6
1.7 6 0.1
0.68 6 0.06
18.4
13.9
40.4
133.6 6 0.8
85.9 6 0.5
All values are age- and sex-adjusted means 6 SEs or percentages across coffee consumption categories, except where otherwise noted. One cup was
defined as 150 mL. EPIC, European Prospective Investigation into Cancer and Nutrition.
2
Unadjusted means 6 SDs or percentages.
3
In current smokers only.
4
n = 18,372.
1
905
2 to ,3 cups/d
3 to ,4 cups/d
4 cups/d
8689/78,974
3860/34,341
10,617/93,272
7356/65,881
12,137/107,290
871
1.00
1.00
1.00
336
0.96 (0.83, 1.11)
0.97 (0.84, 1.13)
0.99 (0.85, 1.14)
979
1.02 (0.92, 1.13)
1.03 (0.92, 1.15)
1.03 (0.92, 1.15)
627
0.96 (0.85, 1.08)
0.93 (0.82, 1.06)
0.95 (0.84, 1.08)
319
1.00
1.00
1.00
137
0.92 (0.72, 1.16)
0.93 (0.73, 1.19)
0.89 (0.69, 1.16)
374
0.93 (0.78, 1.11)
0.92 (0.76, 1.11)
0.92 (0.76, 1.13)
148
1.00
1.00
1.00
50
0.92 (0.64, 1.32)
0.93 (0.64, 1.35)
0.94 (0.64, 1.36)
88
1.00
1.00
1.00
P-trend
Per cup/d
1124
0.99 (0.89, 1.09)
0.93 (0.84, 1.04)
0.94 (0.84, 1.05)
0.735
0.149
0.206
210
0.85 (0.70, 1.04)
0.83 (0.67, 1.02)
0.82 (0.65, 1.02)
392
0.89 (0.75, 1.06)
0.81 (0.67, 0.98)
0.77 (0.63, 0.94)
0.134
0.019
0.009
164
1.07 (0.82, 1.39)
1.08 (0.82, 1.42)
1.07 (0.81, 1.42)
120
1.13 (0.85, 1.49)
1.00 (0.74, 1.36)
1.02 (0.75, 1.38)
222
1.25 (0.98, 1.59)
1.07 (0.82, 1.40)
1.10 (0.84, 1.44)
0.043
0.569
0.435
24
0.65 (0.39, 1.10)
0.61 (0.36, 1.06)
0.62 (0.36, 1.07)
79
0.87 (0.61, 1.24)
0.89 (0.61, 1.29)
0.86 (0.59, 1.25)
70
1.07 (0.74, 1.55)
0.92 (0.61, 1.37)
0.91 (0.61, 1.36)
133
1.19 (0.87, 1.63)
0.98 (0.69, 1.39)
0.98 (0.69, 1.39)
0.114
0.760
0.765
60
1.00
1.00
1.00
26
1.35 (0.80, 2.27)
1.35 (0.79, 2.31)
1.38 (0.81, 2.38)
85
1.41 (0.95, 2.11)
1.35 (0.89, 2.07)
1.39 (0.90, 2.12)
50
1.21 (0.78, 1.88)
1.07 (0.67, 1.73)
1.13 (0.70, 1.82)
89
1.36 (0.93, 2.01)
1.20 (0.78, 1.83)
1.28 (0.83, 1.95)
0.207
0.708
0.488
404
1.00
1.00
1.00
149
0.99 (0.81, 1.22)
1.01 (0.82, 1.25)
1.01 (0.82, 1.25)
441
1.06 (0.91, 1.23)
1.08 (0.92, 1.26)
1.08 (0.92, 1.27)
297
0.97 (0.82, 1.15)
0.98 (0.82, 1.18)
0.98 (0.82, 1.18)
510
0.97 (0.83, 1.12)
0.97 (0.82, 1.14)
0.97 (0.83, 1.14)
0.558
0.553
0.573
1
HRs and 95% CIs were calculated by using multivariate Cox proportional hazard regression. Model 1: stratified by age at recruitment (y) and center
(Potsdam/Heidelberg) and adjusted for sex. Model 2: adjusted as for model 1 with additional adjustment for smoking (status, duration, and intensity), alcohol
intake (nonconsumers; women: .06, .612, or .12 g/d; men: .012, .1224, or .24 g/d), physical activity (average of cycling and sports during
summer and winter; in h/wk), education (none to primary school, technical to secondary school, or higher education including university), employment (yes or
no), vitamin and mineral supplement use during past 4 wk (yes or no), total energy intake (kcal/d), tea intake (cups/d), and decaffeinated coffee intake
(cups/d). Model 3: adjusted as for model 2 with additional adjustment for BMI (kg/m2), waist-to-hip ratio, and prevalent hypertension (yes or no). One cup was
defined as 150 mL. CVD, cardiovascular disease; EPIC, European Prospective Investigation into Cancer and Nutrition.
T2D may differ between subjects with or without prevalent hypertension. We furthermore observed an interaction between caffeinated coffee consumption and smoking. Among nonsmokers, an
inverse association was found between caffeinated coffee consumption and risk of T2D; among current smokers, this dosedependent inverse association was not observed. Because
smoking is an established risk factor for T2D, the adverse effects of smoking may cancel out the potential benefits of coffee
consumption on T2D risk. Thus, we speculate that smokers may
not benefit from coffee consumption in respect of T2D risk.
We found no association between coffee consumption and
CVD risk, including MI and stroke, after multivariate adjustment.
An early meta-analysis of case-control studies found a positive
association between coffee consumption and MI risk, but only
few studies adjusted for smoking or alcohol intake (10). Results
from prospective cohort studies are inconsistent. Some studies
reported that coffee consumption was independently associated
with higher risk of MI (16, 17), whereas other studies and recent
meta-analyses support evidence that there is no harmful relation
No. of subjects/person-years
Overall chronic disease
No. of cases
Model 1
Model 2
Model 3
Type 2 diabetes
No. of cases
Model 1
Model 2
Model 3
Combined CVD
No. of cases
Model 1
Model 2
Model 3
Myocardial infarction
No. of cases
Model 1
Model 2
Model 3
Stroke
No. of cases
Model 1
Model 2
Model 3
Cancer
No. of cases
Model 1
Model 2
Model 3
,1 cup/d
906
FLOEGEL ET AL
TABLE 4
HRs (and 95% CIs) for the association between decaffeinated coffee consumption and incident chronic diseases in EPIC-Germany (n = 42,659)1
Decaffeinated coffee consumption
1 to ,2 cups/d
2 to ,3 cups/d
3 to ,4 cups/d
4 cups/d
38,628/343,062
1273/11,500
1390/12,778
486/4549
882/7868
3493
1.00
1.00
1.00
136
1.18 (0.97, 1.42)
1.13 (0.93, 1.37)
1.12 (0.92, 1.36)
154
1.10 (0.92, 1.32)
1.07 (0.89, 1.28)
0.97 (0.81, 1.17)
45
0.93 (0.68, 1.28)
0.88 (0.64, 1.21)
0.81 (0.59, 1.12)
1262
1.00
1.00
1.00
46
1.14 (0.82, 1.58)
1.04 (0.74, 1.45)
0.97 (0.68, 1.39)
71
1.51 (1.15, 2.00)
1.42 (1.08, 1.88)
1.11 (0.84, 1.48)
621
1.00
1.00
1.00
28
1.47 (0.95, 2.26)
1.39 (0.89, 2.17)
1.41 (0.91, 2.21)
342
1.00
1.00
1.00
P-trend
Per cup/d
109
1.31 (1.06, 1.63)
1.17 (0.94, 1.45)
1.05 (0.84, 1.31)
0.741
0.285
0.620
18
1.06 (0.64, 1.78)
0.96 (0.57, 1.61)
0.70 (0.41, 1.19)
35
1.16 (0.78, 1.72)
0.94 (0.63, 1.40)
0.70 (0.46, 1.06)
0.138
0.007
0.043
27
1.10 (0.71, 1.71)
1.06 (0.68, 1.66)
1.01 (0.64, 1.58)
6
0.76 (0.33, 1.76)
0.73 (0.32, 1.69)
0.73 (0.32, 1.67)
22
1.66 (1.03, 2.65)
1.43 (0.88, 2.32)
1.36 (0.84, 2.20)
0.043
0.338
0.300
17
1.71 (0.98, 2.96)
1.58 (0.88, 2.83)
1.59 (0.89, 2.82)
14
1.42 (0.81, 2.49)
1.38 (0.77, 2.46)
1.28 (0.72, 2.29)
4
0.99 (0.35, 2.75)
0.93 (0.34, 2.58)
0.91 (0.33, 2.50)
17
2.26 (1.30, 3.93)
2.03 (1.15, 3.58)
1.90 (1.08, 3.34)
0.114
0.597
0.575
279
1.00
1.00
1.00
11
1.17 (0.58, 2.35)
1.15 (0.56, 2.35)
1.15 (0.56, 2.35)
13
0.86 (0.44, 1.67)
0.84 (0.43, 1.66)
0.82 (0.42, 1.61)
2
0.52 (0.12, 2.18)
0.51 (0.12, 2.18)
0.51 (0.12, 2.17)
5
0.90 (0.36, 2.27)
0.79 (0.31, 2.01)
0.76 (0.30, 1.93)
0.207
0.476
0.403
1610
1.00
1.00
1.00
62
1.11 (0.84, 1.47)
1.13 (0.85, 1.49)
1.12 (0.85, 1.49)
56
0.83 (0.62, 1.11)
0.82 (0.61, 1.10)
0.82 (0.61, 1.10)
21
0.92 (0.58, 1.45)
0.89 (0.56, 1.42)
0.89 (0.56, 1.42)
52
1.30 (0.96, 1.76)
1.27 (0.93, 1.73)
1.27 (0.94, 1.74)
0.558
0.973
0.950
1
HRs and 95% CIs were calculated by using multivariate Cox proportional hazard regression. Model 1: stratified by age at recruitment (y) and center
(Potsdam/Heidelberg) and adjusted for sex. Model 2: adjusted as for model 1 with additional adjustment for smoking (status, duration, and intensity), alcohol
intake (nonconsumers; women: .06, .612, or .12 g/d; men: .012, .1224, or .24 g/d), physical activity (average of cycling and sports during
summer and winter; in h/wk), education (none to primary school, technical to secondary school, or higher education including university), employment (yes or
no), vitamin and mineral supplement use during past 4 wk (yes or no), total energy intake (kcal/d), tea intake (cups/d), and caffeinated coffee intake (cups/d).
Model 3: adjusted as for model 2 with additional adjustment for BMI (kg/m2), waist-to-hip ratio, and prevalent hypertension (yes or no). One cup was defined
as 150 mL. CVD, cardiovascular disease; EPIC, European Prospective Investigation into Cancer and Nutrition.
plausible explanation for this association is not apparent, because caffeine is considered the relevant factor for a possible
positive association between coffee consumption and MI risk.
We may not have been able to account for all possible confounders associated with high decaffeinated coffee consumption,
eg, participants who are already at high CVD risk may choose to
substitute caffeinated coffee with decaffeinated coffee. Therefore, we speculate that residual confounding may cause the association we observed between high decaffeinated coffee
consumption and increased MI risk. This assumption is supported by the fact that when we excluded all cases that occurred
during the first 2 y of follow-up in the sensitivity analysis, the
positive association between decaffeinated coffee consumption
and MI risk was attenuated and no longer significant. To summarize, previous studies and our findings support the concept
that there may be no harmful effect of coffee on CVD risk per
se. Insufficient consideration of important CVD risk factors that
are linked to coffee consumption (particularly smoking) may be
responsible for the earlier belief that coffee consumption increased CVD risk.
In previous studies, coffee consumption has been found to be
associated with reduced or increased cancer risk, depending on the
type of cancer and study design. Studies investigating the effect of
coffee consumption on total cancer risk are rare. A recent metaanalysis including data from 59 prospective cohort studies found
a 3% reduction in overall cancer risk per cup of coffee consumed
(56). In our study, there was no association between caffeinated or
decaffeinated coffee consumption and total cancer risk.
The strength of our study was that we conducted a first-event
analysis taking into account 4 major chronic diseases to determine
the overall effect of coffee consumption on chronic disease risk and
additionally tested whether the risk associations may compete with
each other. Furthermore, we considered caffeinated and decaffeinated coffee as an exposure. We also included a large subsample of the German population from 2 different regions. Last,
the prospective design of our study allowed us to investigate time-
No. of subjects/person-years
Overall chronic disease
No. of cases
Model 1
Model 2
Model 3
Type 2 diabetes
No. of cases
Model 1
Model 2
Model 3
Combined CVD
No. of cases
Model 1
Model 2
Model 3
Myocardial infarction
No. of cases
Model 1
Model 2
Model 3
Stroke
No. of cases
Model 1
Model 2
Model 3
Cancer
No. of cases
Model 1
Model 2
Model 3
,1 cup/d
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
REFERENCES
1. Grigg D. The worlds of tea and coffee: patterns of consumption. GeoJournal 2003;57:28394.
2. International Coffee Organization. Historical coffee statistics. London,
United Kingdom: International Coffee Organization, 2008. Available
from: http://earthtrends.wri.org/searchable_db/results.php?years=-1&
variable_ID=294&theme=8&cID=62,70,190&ccID= (cited 4 April 2011).
3. Higdon JV, Frei B. Coffee and health: a review of recent human research. Crit Rev Food Sci Nutr 2006;46:10123.
4. Salter H. On some points in the treatment and clinical history of
asthma. Edinburgh Med J 1859;4:110915.
5. Jee SH, He J, Whelton PK, Suh I, Klag MJ. The effect of chronic coffee
drinking on blood pressure: a meta-analysis of controlled clinical trials.
Hypertension 1999;33:64752.
6. Geleijnse JM. Habitual coffee consumption and blood pressure: an
epidemiological perspective. Vasc Health Risk Manag 2008;4:96370.
7. Fried RE, Levine DM, Kwiterovich PO, Diamond EL, Wilder LB, Moy
TF, Pearson TA. The effect of filtered-coffee consumption on plasma
26.
27.
28.
29.
30.
31.
907
908
FLOEGEL ET AL
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
green tea, black tea and oolong tea consumption and risk of mortality
from cardiovascular disease in Japanese men and women. J Epidemiol
Community Health 2011;65(3):23040.
Lopez-Garcia E, Rodriguez-Artalejo F, Li TY, Mukamal KJ, Hu FB,
van Dam RM. Coffee consumption and mortality in women with cardiovasculardisease. Am J Clin Nutr 2011;94(1):21824.
Lopez-Garcia E, van Dam RM, Li TY, Rodriguez-Artalejo F, Hu FB.
The relationship of coffee consumption with mortality. Ann Intern Med
2008;148(12):90414.
Willett WC, Stampfer MJ, Manson JE, Colditz GA, Rosner BA,
Speizer FE, Hennekens CH. Coffee consumption and coronary heart
disease in women. A ten-year follow-up. JAMA 1996;275:45862.
Lopez-Garcia E, van Dam RM, Willett WC, Rimm EB, Manson JE,
Stampfer MJ, Rexrode KM, Hu FB. Coffee consumption and coronary
heart disease in men and women: a prospective cohort study. Circulation 2006;113(17):204553.
Rosner SA, Akesson A, Stampfer MJ, Wolk A. Coffee consumption
and risk of myocardial infarction among older Swedish women. Am J
Epidemiol 2007;165(3):28893.
Nilsson LM, Wennberg M, Lindahl B, Eliasson M, Jansson JH, Van
Guelpen B. Consumption of filtered and boiled coffee and the risk of
first acute myocardial infarction; a nested case/referent study. Nutr
Metab Cardiovasc Dis 2010;20(7):52735.
Klatsky AL, Koplik S, Kipp H, Friedman GD. The confounded relation
of coffee drinking to coronary artery disease. Am J Cardiol 2008;101(6):
8257.
La Vecchia C, DAvanzo B, Negri E, Franceschi S, Gentile A, Tavani
A. Decaffeinated coffee and acute myocardial infarction. A casecontrol study in Italian women. Ann Epidemiol 1993;3:6014.
Sesso HD, Gaziano JM, Buring JE, Hennekens CH. Coffee and tea intake
and the risk of myocardial infarction. Am J Epidemiol 1999;149:1627.
Yu X, Bao Z, Zou J, Dong J. Coffee consumption and risk of cancers:
a meta-analysis of cohort studies. BMC Cancer 2011;11:96.
Colditz GA, Willett WC, Stampfer MJ, Sampson L, Rosner B,
Hennekens CH, Speizer FE. The influence of age, relative weight,
smoking, and alcohol intake on the reproducibility of a dietary questionnaire. Int J Epidemiol 1987;16:3928.
Jee SH, He J, Appel LJ, Whelton PK, Suh I, Klag MJ. Coffee consumption and serum lipids: a meta-analysis of randomized controlled
clinical trials. Am J Epidemiol 2001;153:35362.
Weigel T. Daten und Fakten zur Kaffeeindustrie [Data and facts about
the coffee industry]. Statista, 2011 (in German). Available from: http://
de.statista.com/statistik/faktenbuch/151/a/branche-industrie-markt/
lebensmittelindustrie/kaffeeindustrie/ (cited 17 November 2011).