#74 Coffee: Advice for our Vice?
CLINICAL QUESTION
Does drinking coffee impact mortality or other health outcomes in the general population?
BOTTOM LINE
Coffee consumption is associated with a possible small reduction in mortality in cohort studies. While the evidence is not strong enough to recommend non-drinkers to start consuming coffee, coffee drinkers can be reassured that it does not result in harm (except in pregnancy).
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EVIDENCE
Meta-analysis1 of 21 cohort studies including 997,464 people in US, Europe or Japan
- Largest included cohort study2 followed 402,260 people in US (age 50-71 years) for 14 years
- Drinking coffee was associated with several confounders (more likely to smoke cigarettes, drink alcohol, be physically inactive, and have poor diet)
- After adjusting for confounders, coffee drinkers (compared to those that did not drink coffee), had a statistically significant lower risk of overall mortality:
- About 15% relative risk reduction for 2-3 cups/day
- No dose-response relationship; risk was similar whether individuals drank 1 or 8 cups/day
- Cardiovascular deaths decreased, deaths due to cancer were unchanged.
- Decaffeinated coffee seems to convey similar health benefits, so the benefit may not be due to caffeine.2
- Similar evidence for drinking tea.5
- Evidence is from cohort studies, and therefore can only show association (not causation) with reduced mortality
- Unfortunately, a large randomized controlled trial is unlikely
- However, this evidence seems to rule out clinically important harm.
- Cancer rates: Some research suggests coffee consumption is associated with reduced rates of some cancers,6,7 while other studies find no association.7-10
- Coffee intake is also associated with a reduced risk of diabetes11 and depression.12
- Coffee use in pregnancy (particularly >4 cups/day) increases the risk of fetal loss.13 Pregnant women should be advised of this potential risk.
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