Abstract
Background and aim: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Given the anti-fibrotic and antioxidant properties of coffee, this systematic review and meta-analysis aims to provide updated results on the impact of coffee consumption on NAFLD incidence, prevalence, and risk of significant liver fibrosis. Methods: We conducted a comprehensive search in MEDLINE (OvidSP) and Scopus from January 2010 through January 2021. Relative risks for the highest versus the lowest level of coffee consumption were pooled using random-effects models. Heterogeneity and publication bias were evaluated using the Higgins’ I2 statistic and Egger’s regression test, respectively. Results: Eleven articles consisting of two case-control studies, eight cross-sectional studies, and one prospective cohort study were included in the meta-analysis. Of those, three studies with 92,075 subjects were included in the analysis for NAFLD incidence, eight studies with 9558 subjects for NAFLD prevalence, and five with 4303 subjects were used for the analysis of liver fibrosis. There was no association between coffee consumption and NAFLD incidence (RR 0.88, 95% CI 0.63–1.25, p = 0.48) or NAFLD prevalence (RR 0.88, 95% CI 0.76–1.02, p = 0.09). The meta-analysis showed coffee consumption to be significantly associated with a 35% decreased odds of significant liver fibrosis (RR 0.65, 95% CI 0.54–0.78, p < 0.00001). There was no heterogeneity (I2 = 11%, p = 0.34) and no evidence of publication bias (p = 0.134). Conclusion: This meta-analysis supports the protective role of coffee consumption on significant liver fibrosis in patients with NAFLD. However, the threshold of coffee consumption to achieve hepatoprotective effects needs to be established in prospective trials.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in North America and is one of the main health complications seen around the world
We consider significant liver fibrosis as a histological score greater than or equal to F2 according METAVIR or elastography >8 kPa. All these studies assessed liver fibrosis in a single time-point and we present the results as liver fibrosis associated with NAFLD but not the fibrosis progression in NAFLD, as assessing progression requires more than one-time measurements
Three studies with 92,075 subjects [21,22,23] were included in the analysis for NAFLD incidence, eight studies with 9558 subjects for NAFLD prevalence [11,16,23,24,25,26,27,28], and five studies with 4303 subjects were used for the analysis of significant liver fibrosis risk [11,23,28,29]
Summary
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in North America and is one of the main health complications seen around the world. A change in its nomenclature to Metabolic-Associated Fatty Liver Disease (MAFLD) [1,2] has been proposed by a group of experts. This acronym seems to better capture pathogenesis but has not been widely accepted. Given the anti-fibrotic and antioxidant properties of coffee, this systematic review and meta-analysis aims to provide updated results on the impact of coffee consumption on NAFLD incidence, prevalence, and risk of significant liver fibrosis. The meta-analysis showed coffee consumption to be significantly associated with a 35% decreased odds of significant liver fibrosis (RR 0.65, 95% CI 0.54–0.78, p < 0.00001). Conclusion: This meta-analysis supports the protective role of coffee consumption on significant liver fibrosis in patients with NAFLD. The threshold of coffee consumption to achieve hepatoprotective effects needs to be established in prospective trials
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