ISIC-Diabetes-Report-2013-FINAL.pdf

7th November 2013

Good things in life: Can coffee help in type 2 diabetes risk reduction?

ISIC the Institute for Scientific Information on Coffee

14th November 2013

Contents Page1 Introduction 2

2 Epidemiologicalevidence 3

3 Clinicalinterventiontrials 4

4 Clinicalparameters 5

5 Underlyingmechanisms 6

6 Conclusions 7

17th November 2013

Good things in life: Can coffee help in diabetes prevention?

Basepoint Evesham, Crab Apple Way, Evesham, Worcestershire WR11 1GP Tel: +44 (0) 1386 764777 Email: [email protected] Web: www.coffeeandhealth.org

2ISIC the Institute for Scientific Information on Coffee 7th November 2013

InstituteforScientificInformationonCoffee(ISIC)TheInstituteforScientificInformationonCoffee(ISIC)isanot-for-profitorganisation,establishedin1990anddevotedtothestudyanddisclosureofsciencerelatedtocoffeeandhealth.Since2003ISIChasalsosupportedapan-Europeaneducationprogramme,workinginpartnershipwithnationalcoffeeassociationsinninecountriestoconveycurrentscientificknowledgeoncoffeeandhealthtohealthcareprofessionals.

ISICrespectsscientificresearchethicsinallitsactivities.ISICscommunicationsarebasedonsoundscienceandrelyonevidenceandscientificstudiesderivedfrompeer-reviewedscientificjournalsandotherpublications.

www.coffeeandhealth.org

1.INTRODUCTION

Morethan370millionpeopleworldwidehavediabetesmakingitoneofthemostsignificanthealthproblems1.Worldwide4.8millionpeoplediedand$471billionwerespentasaresultofdiabetesduring2012andtheWorldHealthOrganisationpredictsthatdeathscausedbydiabeteswillincreasebytwothirdsbetween2008and20302.

InEuropetheprevalenceofdiabetesamountsto6.7%or55millionsufferers.Ofthis,38.6%ofcasesremainundiagnosed,whichmeansthat21.2millionEuropeansareunawarethattheyhavediabetes.Itispredictedthatby2030thenumberofpeoplewithdiabetesintheEUwillriseto64million1.

Onceadiseaseofoldage,type2diabetesisnowincreasinglyaffectingyoungerpeopleandthehighestincreaseisinthe30-40yearoldagegroup3.

Thetwinepidemicsofobesityandtype2diabetesalreadyrepresentthebiggestpublichealthchallengeofthe21stcentury.Itisestimatedthatatleasthalfofalltype2diabetescaseswouldbeeliminatedifweightgaininadultscouldbeprevented4.

Type2diabetesischaracterisedbyhighbloodglucose,togetherwithinsulinresistanceandrelativeinsulindeficiency.Type2diabetesisprimarilyinfluencedbylifestylefactorssuchasdiet,physicalactivity,obesityandage.

Coffeeisawidelyconsumedbeverageandresearchsuggeststhatcoffeeconsumptionmayhelptoreducetheriskofdevelopingtype2diabetes.

Thissummaryofuptodateresearchintocoffeeandtype2diabetesisbasedonareportfromtheWorldCongressonPreventionofDiabetesheldin2012,updatedtoincludethelatestresearchinthisarea.




2.EPIDEMIOLOGICALEVIDENCE

Epidemiologicalevidenceshowsthatdrinkingthreetofourcupsofcoffeeperdayisassociatedwithanapproximate25%lowerriskofdevelopingtype2diabetes,comparedtoconsumingnoneorlessthantwocupsperday5.

Anearlystudy,publishedmorethantenyearsago6,investigatedtheassociationbetweencoffeeconsumptionandriskoftype2diabetesinacohortof17,111adultsaged30-60.Overthefollowupperiod,360newcasesoftype2diabeteswereidentifiedandafteradjustingforpotentialconfounders,individualswhodrankatleastsevencupsofcoffeeadaywerehalfaslikelytodeveloptype2diabetesthanthosewhodranktwocupsorfewer.Amorerecentstudyamongapopulation-basedcohortofmiddle-agedChinesepeople7,alsofoundcoffeeintaketobeinverselyassociatedwithtype2diabetes.

Furthermore,tworeviewpapers,bothpublishedin2012,addtotheexistingbodyofevidencesuggestingthathabitualcoffeeconsumptionisassociatedwithalowerriskoftype2diabetes8,9.Thefirstsystematicreview8concludedthathabitualcoffeeconsumptionisassociatedwithalowerriskoftype2diabetes.Participantswhodrankfourtosixcupsandmorethansixtosevencupsofcoffeeperdayhadalowerriskoftype2diabetescomparedwiththosewhodranklessthantwocupsperday.Theauthorsconcludedthatmoredetailedstudiesofcoffeeconsumption,includingappropriatemeasuresofpostprandialhyperglycemiaandinsulinsensitivity,arerequired.Asecondreview9discussedthestrengthofthisrelationshipandassessedthepossiblemechanismsbywhichcoffeecomponentsmightaffectdiabetesdevelopment,especiallyinlightoftheparadoxicaleffectofcaffeineonglucosemetabolism(seesection5formoreinformationonunderlyingmechanisms).

2.1.DoseresponseResearchhasalsosuggestedadoseresponseeffectofdrinkingcoffeeanditspossibleprotectionagainsttype2diabetes.Asystematicreviewwithmeta-analysis5studiedtheavailableprospectiveepidemiologicalstudiesontype2diabetesandcoffeefromeightdifferentcountries.Theresultsshowedastatisticallysignificantinverseassociationbetweencoffeeconsumptionandsubsequentriskoftype2diabetes,witheachadditionalcupofcoffeereducingtherelativeriskby7-8%.Anewmeta-analysishassupportedthiseffect,inadose-responseanalysistheresearchersfoundthattheincidenceoftype2diabetesdecreasedby12%forevery2additionalcupsperdayofcoffee10.

2.2.Coffeeandtype2diabetesriskfactorsObservationalstudieshavealsoshownthatcoffeeconsumptioncanhaveanimpactonriskfactorsfortype2diabetes.Forinstance,researchhasfoundthatcoffeeconsumptionisassociatedwithlowerC-peptide,especiallyintheoverweightorobese11,withhigherlevelsofadiponectin11andwithlowerleversofinflammatorymarkers12.

2.3.TimeofconsumptionResearchhasalsosuggestedthatthetimeofcoffeeconsumptioncouldplayadistinctroleinglucosemetabolism.Oneprospectivecohortstudy3of69,532Frenchwomenexaminedthelong-termeffectsofcoffeeontype2diabetesandfounddrinkingcoffee,especiallyatlunchtime,reducedtheriskofdevelopingdiabetes.

2.4.CoffeetypeWhilstthemajorityofresearchhasbeenconductedoncaffeinatedfilteredcoffee,therehavealsobeenepidemiologicalstudiesthathaveidentifiedaninverseassociationbetweenboiledcoffee13,14anddecaffeinatedcoffee5.Researchpublishedin201215supportedtheearlierworksuggestingthatbothcaffeinatedanddecaffeinatedcoffeeareassociatedwithalowerriskoftype2diabeteswhilstfurtherrecentwork8showedanadvantageoffilteredcoffeeoverpotboiled,decaffeinatedcoffeeovercaffeinatedcoffeeandastrongerinversecorrelationinthoseunder60yearsagegroup.However,recentresultsfromtheHawaiicomponentoftheMultiethnicCohort16suggestedthatregularbutnotdecaffeinatedcoffeewasmuchmoreprotectiveagainsttype2diabetesinwomenofallethnicgroupsthaninmen.Furtherresearchisrequiredinthisareatoconfirmtheassociations.




3.CLINICALINTERVENTIONTRIALS

Whilststudieshaveclearlyillustratedanassociationbetweencoffeeconsumptionandreducedtype2diabetesrisk,adefinitecausalrelationshipisyettobeestablished.Clinicalinterventiontrialsarehelpingtoestablishthis.

3.1.SingledosestudiesStudieshaveinvestigatedtheeffectofasingledoseofcoffeeonglucosemetabolism.Thesehaveshownnobeneficialeffectsinoralglucosetolerancetests(OGTT),howeversomestudieshaveshownamodestincreaseininsulinresistance,attributedtocaffeine.Oneprospectiverandomisedcontrolledtrial17,testedglucoseandinsulinafteranoralglucosetolerancetestwith12gdecaffeinatedcoffee,1gchlorogenicacid,500mgtrigonelline,orplacebo.Thisstudydemonstratedthatchlorogenicacid,andtrigonellinereducedearlyglucoseandinsulinresponses,andcontributetotheputativebeneficialeffectofcoffee.

3.2.LongertermcoffeeconsumptionResearchassessinglongertermcoffeeconsumptioninoverweightmales18hassuggestedthatbothcaffeinatedanddecaffeinatedcoffeeareassociatedwithamodestdecreaseinpostloadglucoselevels,withtheauthorsconcludingthatcoffeemaybeprotectiveagainstdeteriorationofglucosetolerance.Thisissupportedbya2012study19,whichalsofoundcoffeedrinkingtobeprotectiveagainstglucoseintoleranceinacohortofmiddle-agedJapanesemen.

Areviewofrandomisedcontrolledtrials(RCTs)investigatingtheeffectsofcaffeineonbloodglucoseand/orinsulinsensitivityinhumans,diagnosedwithtype1,type2orgestationaldiabetesmellitus(GDM)20,suggestedthatcaffeinehasanegativeeffectonbloodglucosecontrolinindividualswithtype2diabetes,buttheauthorsconcludedthatfurtherworkwasrequired.




4.CLINICALPARAMETERS

Drinkingcoffeeisoftenlinkedtounhealthierhabits,suchassmokingandlowlevelsofphysicalactivity,yetcounterintuitivelyithasalsobeenassociatedwithareducedriskoftype2diabetes.Sohowsignificantareclinicalparametersrelatingtocoffeeandtype2diabetes?

4.1.CoffeeandhormonesCoffeeconsumptionhasbeendemonstratedtoincreaselevelsofthehormoneadiponectin,whichhasbeenshowntoincreaseinsulinsensitivity.Thiseffecthasbeenobservedinbothdiabeticandnon-diabeticindividuals12.

4.2.CoffeeandchronicdiseasesInadditiontoitspossibleeffectsontype2diabetes,researchsuggeststhatcoffeedoesnotincreasetheriskofcertainchronicdiseases.Infact,itisinverselyassociatedwithsomecancers,includingbladder,breast,colorectal,liver,pancreas,andprostatecancers.Thisisimportanttonote,asindividualswithtype2diabetesalsohaveanincreasedriskofdevelopingcertaincancers.

4.3.Coffee,cholesterolandcardiovasculardiseaseSomeresearchhasshownthatunfiltered,butnotfiltered,coffeeincreasesserumlevelsoftotalandLDLcholesterol21,22.However,inasmallclinicaltrial,abeneficialeffectonHDLcholesterollevelswasdemonstratedamongstcoffeedrinkers23.Also,despiteahighcirculatingcholesterolbeingakeyriskfactorforcardiovasculardisease(CVD),otherstudieshaveillustratedthatcoffeeconsumptionisnotassociatedwithanincreasedriskofhypertension,strokeorcoronaryheartdisease24,25,26.ResearchinpatientswithCVDhasalsoshownthatmoderatecoffeeconsumptionisinverselyassociatedwithriskofheartfailure,withaJ-shapedrelationship27.Additionalsupportforthisisprovidedbyatenyearfollowupstudy28inwhichcoffeeconsumptionwasassociatedwithalowerriskofcoronaryheartdiseasemortality.Furthermore,indiabeticpatientscoffeeconsumptionwasnotassociatedwithincreasedriskforCVDorprematuremortalityamongdiabeticwomen29.

4.4.CoffeeandtheliverAhealthyliverhelpskeepbloodglucosewithinthenormalrangeandprotectsagainstdiabeticcomplications.Coffeeconsumptionisalsoassociatedwithhigherlevelsoffetuin-A,abiomarkerforinflammationandliverfunction.Itisaglycoproteinsecretedbythehepatocyteswitheffectsoninsulinsignalingviainhibitionoftheinsulinreceptortyrosinekinaseinbothliverandskeletaltissue30,31.Indeed,arecentrandomizedcontroltrial32concludedthatimprovementsinadipocyteandliverfunctionasindicatedbychangesinadiponectinandfeutin-Aconcentrationsmaycontributetothebeneficialmetaboliceffectsoflongtermcoffeeconsumption.

Additionally,crosssectionalstudieshaveshowncoffeeconsumptiontobelinkedwithlowerlevelsofmarkersofliverdamage3andasignificantreductioninriskoffibrosisamongNonAlcoholicSteatohepatitispatients34.




5.UNDERLYINGMECHANISMS

5.1.TheCoffeeConundrumCoffeeconsumptionhasbeenassociatedwithadecreasedriskofdevelopingtype2diabetes,howeveracausalrelationshiphasyettobeestablished.Inordertoexplainthisrelationship,therearetwokeyquestionsthatneedtobeanswered:

5.1.1.Whatisthephysiology?Thereareanumberofpotentialphysiologicalprocessesthatmayleadtothereducedriskoftype2diabetes.Forexample,itcouldbeduetoenergymetabolism,wherebycoffeeconsumptioncausesanincreaseincalorieburning,orperhapscoffeeaffectsglucosemetabolismcausingthebodytohandleglucosedifferently.Alternatively,coffeecouldaffectinsulinsensitivityinthebody,forexample,aSingaporeProspectiveStudy35foundaninverseassociationbetweencoffeeconsumptionandHOMA-IR,awellrecognisedmarkerofinsulinresistance.Afurthercross-sectionalstudy36showedthatcaffeinatedcoffeewaspositivelyrelatedtoinsulinsensitivityanddecaffeinatedcoffeewasfavourablyrelatedtomeasuresofbetacellfunction.

Anotherpossibilityisthatitcouldsimplybeaneffectofcaloriedisplacement,wherechoosingcoffeeoverasugarydrinkleadstoareductionincalorieconsumption.

5.1.2.Whatcoffeecompoundsareresponsible?Thesecondchallengeistoidentifythecompoundswithincoffeewhicharecausingtheeffect.Itcouldbeaknownbioactivecomponentincoffee,orevenabioactivesubstancethathasyettobeidentified.Alternativelyitcouldbenutrientsuchasaspecificvitaminormineral.Caffeinehasbeensuggestedastheingredientresponsibleforthebeneficialeffects.Andagain,itisalsopossiblethattheeffectistheresultoftheabsenceofasubstance,causedbydisplacementbydrinkingcoffeeinplaceofotherbeverages.

Althoughaconsensushasyettobereachedregardingthemechanismsthatunderlietheassociationbetweencoffeeconsumptionandtype2diabetes,anumberofplausibletheoriesexist.Theseinclude,butarenotlimitedto,thefollowing:

5.2.EnergyExpenditureHypothesisOnetheoryisthatcaffeinestimulatesmetabolismandincreasesenergyexpenditure.Caffeineactsasanantagonisttoadenosinereceptors,whichplayanimportantroleinenergytransfer.ThiseffectleadstoabuildupofcAMPconcentrationwhich,inturn,increasesthebasalmetabolicratethiscanleadtoanetincreaseincaloriesburntofupto150cal/day.However,thelimitationofthistheoryisthatexperimentaldatasuggeststhathighlevelsofcaffeinearerequired,intheregionof600-1200mg/day.Thisistheequivalentof6-12cupsofcoffeeaday.

5.3.CarbohydrateMetabolicHypothesisAnothermechanistictheoryhassuggestedthatchlorogenicacidincoffeemayplayanimportantrolebyinfluencingtheglucosebalancewithinthebody.Thisisbecausechlorogenicacidmayinhibitcarbohydratedigestionorglucoseabsorption,whichcausesglucoseconcentrationsinthelivertodecrease.Thisisthoughttomodifytheresponsesofcertainhormonesthatcauseanincreaseintheamountofinsulinreleased.

5.4.InsulinSensitivityHypothesisThereisalsoasubsetofpotentialmechanismsrelatingtoinsulinsensitivity.




5.4.1.AntiinflammationCoffeecontainscomponentsthatmaymodulateinflammatorypathwaysinthebodyleadingtoimprovedinsulinsensitivity.PotentialcomponentsthathavebeenindentifiedincludeCaffeicacidphenthylester,diterpenesor3-methyl-1,2-cyclopentanedione.

5.4.2.AntioxidantsCoffeecontainsantioxidants,suchaschlorogenicacidandN-methylpryridium,andthesehavebeenshowntomediatetheoxidativestressofcellsandimproveinsulinsensitivity.

5.4.3.HormonaleffectsSomecomponentsfoundincoffeemayinteractwithcortisolmetabolism.Oneinvitrostudyfoundthatanundeterminedbioactivecomponentincoffeecausedadecreaseincellularcortisolconcentrations,whichcouldimproveinsulinsensitivity.

5.4.4.IronChelationCoffeecontainsphenolicsandmelanoidinsincoffeethatmaychelateiron.Studieshavesuggestedthatareductioninironstoresmayimproveinsulinsensitivityorcardiovascularhealth.

6.CONCLUSIONS

Theresearchoutlinedinthisreportsuggeststhatregularmoderatecoffeeconsumptionmayactuallydecreaseanindividualsriskofdevelopingtype2diabetes.Thiseffecthasbeenlinkedwithhigheradiponectinlevels,adecreaseininflammatorymarkersandreducedsubclinicalinflammation.Furthermore,adose-dependent,inverseassociationbetweenbothcoffeedrinkingandtotalmortalityhasbeendemonstratedinthegeneralpopulation,aswellasamongdiabetics.

Studieshavealsofoundthatdrinkingcoffeedoesnotincreasecancerriskinthediabeticpopulation,nordoesitcausecardiovasculardisease,hypertensionorstroke.Althoughmoreresearchisneededtomakefirmconclusions,thefindingssuggestthatcoffeeinmoderationcanbesafelyenjoyedbythehealthyaswellasbythediabeticpopulationandmightevenbehelpfulintype2diabetesprevention.




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ISIC-Diabetes-Report-2013-FINAL.pdf