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Coffee and HCC. Retrospective, cross-sectional studies have suggested that coffee drinking has
numerous health benefits in a variety of disease states. In a recent review of cross sectional and case
control studies in chronic liver disease, regular coffee consumption was associated with a lower risk of
progression to cirrhosis, lower mortality rate in cirrhotics and lower rate of HCC development with an
inverse association between coffee consumption and severity of NASH [31].When analysis is restricted
to non-viral cirrhosis only, the link between coffee drinking and protection from cirrhotic mortality is
maintained [32]. However, in a recent small prospective observational study, the incidence of NAFLD
was not related to coffee consumption [33]. Rather it was in those with established NAFLD (determined
by ultrasound) that higher coffee consumption (≥3 cups per day) was associated with lower likelihood
of significant fibrosis (assessed by FibroTest).
There are a number of difficulties in interpreting studies regarding health benefits of coffee drinking.
Coffee is composed of >100 compounds, any of which may synergistically contribute to ‘hepatoprotective’
health benefits. Coffee is consumed in many different forms, e.g. filtered and unfiltered, with wide-
ranging polyphenol content depending on country of origin and processing, and there is no standardized
cup size.Therefore, determining the dose or exposure to ‘coffee’ in populations across different countries
and cuisines raises difficulties. Furthermore, high coffee consumption has been linked with a number
of confounding variables such as higher rates of smoking, higher sugar consumption and lower physical
activity [33]. While the emerging evidence suggests a role for coffee drinking as a beneficial health
behaviour in people with liver disease, blinded randomized controlled trials are needed to provide
evidence for caution and/or treatment effects in patients with NASH and NASH-related HCC.
Recommendations
Physicians are encouraged to recommend lifestyle changes for patients after curative therapy for HCC
on the basis of beneficial health outcomes, such as reduced steatosis, improved body composition,
fitness and quality of life. However, future research is needed to inform dosing, the magnitude of effects
that can be expected and the assessment of the impact of these measures on cancer recurrence and
cancer related death [23].
References
[1] Thoma C, Day CP,Trenell MI. Lifestyle interventions for the treatment of non-alcoholic fatty liver
disease in adults: a systematic review. J Hepatol 2012;56:255-266.
[2] Peng L,Wang J, Li F.Weight reduction for non-alcoholic fatty liver disease. Cochrane Database Syst
Rev 2011:CD003619.
[3] Bugianesi E, Gastaldelli A, Vanni E, et al. Insulin resistance in non-diabetic patients with non-
alcoholic fatty liver disease: sites and mechanisms. Diabetologia 2005;48:634-642.
[4] Ross R, Dagnone D, Jones PJ, et al. Reduction in obesity and related comorbid conditions after
diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial.
Ann Intern Med 2000;133:92-103.
[5] Hickman IJ, Byrne NM, Croci I, et al. A pilot randomised study of the metabolic and histological
effects of exercise in non-alcoholic steatohepatitis. J Diabetes Metab 2013;4:300-310.
[6] Segal KR, Edano A, Abalos A, et al. Effect of exercise training on insulin sensitivity and glucose
metabolism in lean, obese, and diabetic men. J Appl Physiol 1991;71:2402-2411.
[7] DeFronzo RA,Tripathy D. Skeletal muscle insulin resistance is the primary defect in type 2 diabetes.
Diabetes Care 2009;32 Suppl 2:S157-163.
[8] Promrat K, Kleiner DE, Niemeier HM, et al. Randomized controlled trial testing the effects of
weight loss on nonalcoholic steatohepatitis. Hepatology 2010;51:121-129.
[9] Sullivan S,Kirk EP,Mittendorfer B,et al.Randomized trial of exercise effect on intrahepatic triglyceride
content and lipid kinetics in nonalcoholic fatty liver disease. Hepatology 2012;55:1738-1745.
[10] Hallsworth K, Fattakhova G, Hollingsworth KG, et al. Resistance exercise reduces liver fat and its
mediators in non-alcoholic fatty liver disease independent of weight loss. Gut 2011;60:1278-1283.
[11] Johnson NA, SachinwallaT,Walton DW, et al. Aerobic exercise training reduces hepatic and visceral
lipids in obese individuals without weight loss. Hepatology 2009;50:1105-1112.
[12] Kistler KD, Brunt EM, Clark JM, et al. Physical activity recommendations, exercise intensity, and
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 91
numerous health benefits in a variety of disease states. In a recent review of cross sectional and case
control studies in chronic liver disease, regular coffee consumption was associated with a lower risk of
progression to cirrhosis, lower mortality rate in cirrhotics and lower rate of HCC development with an
inverse association between coffee consumption and severity of NASH [31].When analysis is restricted
to non-viral cirrhosis only, the link between coffee drinking and protection from cirrhotic mortality is
maintained [32]. However, in a recent small prospective observational study, the incidence of NAFLD
was not related to coffee consumption [33]. Rather it was in those with established NAFLD (determined
by ultrasound) that higher coffee consumption (≥3 cups per day) was associated with lower likelihood
of significant fibrosis (assessed by FibroTest).
There are a number of difficulties in interpreting studies regarding health benefits of coffee drinking.
Coffee is composed of >100 compounds, any of which may synergistically contribute to ‘hepatoprotective’
health benefits. Coffee is consumed in many different forms, e.g. filtered and unfiltered, with wide-
ranging polyphenol content depending on country of origin and processing, and there is no standardized
cup size.Therefore, determining the dose or exposure to ‘coffee’ in populations across different countries
and cuisines raises difficulties. Furthermore, high coffee consumption has been linked with a number
of confounding variables such as higher rates of smoking, higher sugar consumption and lower physical
activity [33]. While the emerging evidence suggests a role for coffee drinking as a beneficial health
behaviour in people with liver disease, blinded randomized controlled trials are needed to provide
evidence for caution and/or treatment effects in patients with NASH and NASH-related HCC.
Recommendations
Physicians are encouraged to recommend lifestyle changes for patients after curative therapy for HCC
on the basis of beneficial health outcomes, such as reduced steatosis, improved body composition,
fitness and quality of life. However, future research is needed to inform dosing, the magnitude of effects
that can be expected and the assessment of the impact of these measures on cancer recurrence and
cancer related death [23].
References
[1] Thoma C, Day CP,Trenell MI. Lifestyle interventions for the treatment of non-alcoholic fatty liver
disease in adults: a systematic review. J Hepatol 2012;56:255-266.
[2] Peng L,Wang J, Li F.Weight reduction for non-alcoholic fatty liver disease. Cochrane Database Syst
Rev 2011:CD003619.
[3] Bugianesi E, Gastaldelli A, Vanni E, et al. Insulin resistance in non-diabetic patients with non-
alcoholic fatty liver disease: sites and mechanisms. Diabetologia 2005;48:634-642.
[4] Ross R, Dagnone D, Jones PJ, et al. Reduction in obesity and related comorbid conditions after
diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial.
Ann Intern Med 2000;133:92-103.
[5] Hickman IJ, Byrne NM, Croci I, et al. A pilot randomised study of the metabolic and histological
effects of exercise in non-alcoholic steatohepatitis. J Diabetes Metab 2013;4:300-310.
[6] Segal KR, Edano A, Abalos A, et al. Effect of exercise training on insulin sensitivity and glucose
metabolism in lean, obese, and diabetic men. J Appl Physiol 1991;71:2402-2411.
[7] DeFronzo RA,Tripathy D. Skeletal muscle insulin resistance is the primary defect in type 2 diabetes.
Diabetes Care 2009;32 Suppl 2:S157-163.
[8] Promrat K, Kleiner DE, Niemeier HM, et al. Randomized controlled trial testing the effects of
weight loss on nonalcoholic steatohepatitis. Hepatology 2010;51:121-129.
[9] Sullivan S,Kirk EP,Mittendorfer B,et al.Randomized trial of exercise effect on intrahepatic triglyceride
content and lipid kinetics in nonalcoholic fatty liver disease. Hepatology 2012;55:1738-1745.
[10] Hallsworth K, Fattakhova G, Hollingsworth KG, et al. Resistance exercise reduces liver fat and its
mediators in non-alcoholic fatty liver disease independent of weight loss. Gut 2011;60:1278-1283.
[11] Johnson NA, SachinwallaT,Walton DW, et al. Aerobic exercise training reduces hepatic and visceral
lipids in obese individuals without weight loss. Hepatology 2009;50:1105-1112.
[12] Kistler KD, Brunt EM, Clark JM, et al. Physical activity recommendations, exercise intensity, and
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 91
