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Is Coffee Harmful? If Looking for Longevity, Say Yes to the Coffee, No to the Sugar

      Letter to the Editor:
      Liu et al
      • Liu J.
      • Sui X.
      • Lavie C.J.
      • et al.
      Association of coffee consumption with all-cause and cardiovascular disease mortality.
      reported a significant increase in all-cause mortality for men (hazard ratio, 1.56; 95% CI, 1.30-1.87) and women (hazard ratio, 2.13; 95% CI, 1.26-3.59) younger than 55 years who consumed more than 4 cups of coffee per day. The data came from a longitudinal study that measured coffee consumption preceding mortality by as much as 32 years. We can be much more confident of temporality than causality in this study. In fact, there are several reasons to believe that the associations found are not causal. First, all but the associations between the highest levels of coffee drinking and mortality became statistically insignificant in fully adjusted models. Second, the “fully” adjusted models did not include potentially important confounders, only some of which have been discussed in previous critiques.
      • Liu J.
      • Sui X.
      • Blair S.N.
      • Lavie C.J.
      In reply—association of coffee consumption with all-cause and cardiovascular disease mortality.
      One earlier critic raised issues of sleep disorders and insomnia for which the authors did not adjust. To these unconsidered conditions, we would like to add occupational and medical issues related to fatigue and alertness and the potential desire for stimulation through caffeinated beverages such as coffee. For instance, consuming coffee has exhibited benefits for patients with certain high-risk jobs (eg, commercial driving
      • Sharwood L.N.
      • Elkington J.
      • Meuleners L.
      • Ivers R.
      • Boufous S.
      • Stevenson M.
      Use of caffeinated substances and risk of crashes in long distance drivers of commercial vehicles: case-control study.
      and certain shift work
      • Muehlbach M.J.
      • Walsh J.K.
      The effects of caffeine on simulated night-shift work and subsequent daytime sleep.
      ) and fatiguing diseases (eg, major depression,
      • Ruusunen A.
      • Lehto S.M.
      • Tolmunen T.
      • Mursu J.
      • Kaplan G.A.
      • Voutilainen S.
      Coffee, tea and caffeine intake and the risk of severe depression in middle-aged Finnish men: the Kuopio Ischaemic Heart Disease Risk Factor Study.
      cancer,
      • Wilson K.M.
      • Kasperzyk J.L.
      • Rider J.R.
      • et al.
      Coffee consumption and prostate cancer risk and progression in the Health Professionals Follow-up Study.
      • Bravi F.
      • Bosetti C.
      • Tavani A.
      • Gallus S.
      • La Vecchia C.
      Coffee reduces risk for hepatocellular carcinoma: an updated meta-analysis.
      and autoimmune disease
      • Andersen I.M.
      • Tengesdal G.
      • Lie B.A.
      • Boberg K.M.
      • Karlsen T.H.
      • Hov J.R.
      Effects of coffee consumption, smoking, and hormones on risk for primary sclerosing cholangitis.
      ). Consumption of 4 or more cups of coffee in those younger than 55 years may simply capture more patients in the aforementioned groups, who are also at an increased risk of early mortality
      • Ariyo A.A.
      • Haan M.
      • Tangen C.M.
      • et al.
      Cardiovascular Health Study Collaborative Research Group
      Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans.
      • Walsh S.J.
      • Rau L.M.
      Autoimmune diseases: a leading cause of death among young and middle-aged women in the United States.
      • Thomas S.L.
      • Griffiths C.
      • Smeeth L.
      • Rooney C.
      • Hall A.J.
      Burden of mortality associated with autoimmune diseases among females in the United Kingdom.
      —or, at least, events that can be fatal.
      • Vyas M.V.
      • Garg A.X.
      • Iansavichus A.V.
      • et al.
      Shift work and vascular events: systematic review and meta-analysis.
      Third, coffee consumption might just be a marker of other less-healthy food consumption, unmeasured and not addressed by Liu et al. For instance, how often did people's cups of coffee accompany servings of donuts, bagels, toast and jam, or other refined and sugary goods? And how often did people drink their coffee with sweetened creamer or added sugar? It has been known for at least half a century that atherosclerosis is proportional to the amount of dietary sugar and that much of the dietary sugar people consume may be taken in cups of coffee.
      • Yudkin J.
      • Roddy J.
      Levels of dietary sucrose in patients with occlusive atherosclerotic disease.
      A study conducted 50 years ago found that patients who experienced myocardial infarction consumed greater amounts of sugar overall as well as added larger amounts of sugar to their cups of coffee as compared with controls.
      • Yudkin J.
      • Roddy J.
      Levels of dietary sucrose in patients with occlusive atherosclerotic disease.
      More contemporary research on the cardiometabolic harms of sugar-sweetened beverages suggest that the customization of coffee might be more important for negative health consequences than the beverage itself.
      • Cox C.L.
      • Stanhope K.L.
      • Schwarz J.M.
      • et al.
      Circulating concentrations of monocyte chemoattractant protein-1, plasminogen activator inhibitor-1, and soluble leukocyte adhesion molecule-1 in overweight/obese men and women consuming fructose- or glucose-sweetened beverages for 10 weeks.
      • Te Morenga L.
      • Mallard S.
      • Mann J.
      Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies.
      • Schulze M.B.
      • Manson J.E.
      • Ludwig D.S.
      • et al.
      Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women.
      Indeed, coffee itself may be quite healthy. There are myriad potential bodily benefits of coffee consumption,
      • O'Keefe J.H.
      • Bhatti S.K.
      • Patil H.R.
      • DiNicolantonio J.J.
      • Lucan S.C.
      • Lavie C.J.
      Effects of habitual coffee consumption on cardiometabolic disease, cardiovascular health, and all-cause mortality.
      with prior reports establishing reductions in both disease-specific
      • Greenberg J.A.
      • Dunbar C.C.
      • Schnoll R.
      • Kokolis R.
      • Kokolis S.
      • Kassotis J.
      Caffeinated beverage intake and the risk of heart-disease mortality in the elderly: a prospective analysis.
      • Freedman N.D.
      • Park Y.
      • Abnet C.C.
      • Hollenbeck A.R.
      • Sinha R.
      Association of coffee drinking with total and cause-specific mortality.
      and all-cause mortality.
      • Lopez-Garcia E.
      • van Dam R.M.
      • Li T.Y.
      • Rodriguez-Artalejo F.
      • Hu F.B.
      The relationship of coffee consumption with mortality.
      Coffee is enjoyed by diverse populations worldwide and is the most consumed beverage in the world among adults after plain water.
      National Coffee Association USA
      National Coffee Drinking Trends 2012.
      It would be a shame to brew up concern about this beloved beverage owing to analyses flawed in part by confounding from unmeasured disease states and unaddressed dietary intake.

      References

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        Use of caffeinated substances and risk of crashes in long distance drivers of commercial vehicles: case-control study.
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