journal club meena meka md. topic association of coffee drinking with total and cause-specific...

Journal Club

Meena Meka MD

Topic

• Association of Coffee Drinking with Total and Cause-Specific Mortality

Background

• Coffee is one of the most widely consumed beverages, but the association between coffee consumption and the risk of death remains unclear.

PICO Question

• Patient• Intervention• Control• Outcome

PICO

• Patient:

PICO Question

• Intervention

PICO Question

• Control:

PICO Question

• Outcome

The Article

• Association of Coffee Drinking with Total and Cause Specific Mortality.

• New England Journal of Medicine• 2012;366:1891-1904

The Article

• Original Research• Prospective, multicenter• Journal – peer reviewed, general internal

medicine• Sites: multicenter• Patients: 229,118 men and 173,141 women

Patient Criteria

• Inclusion– 50-71years

• Exclusion– Persons whose

questionnaires were completed by others

– Cancer– Heart disease– Previous stroke

Other exclusions

• Persons who did not provide information on coffee use

• Extremely low or high caloric consumption• Those who died before completed

questionnaire was received

Study Population

• 617,119 AARP members 50-71 years of age returned a comprehensive questionnaire assessing diet and lifestyle

• Participants resided in 6 states, CA, FL, LO, NJ, NC, PN, and 2 metropolitan areas, Atlanta and Detroit

• 566,401 completed the questionnaire satisfactorily

Methods

• Participants completed the baseline questionnaire that assessed demographic and lifestyle characteristics and 124 dietary items

• Consumption of fruits, vegetables, red meat, white meat, unsaturated fat were adjusted for total energy intake with the use of the nutrient density approach

• Coffee consumption was assessed according to 10 frequency categories ranging from 0-6 or more cups a day

Methods

• 96.5% of coffee drinkers provided information on whether they drank caffeinated or decaffeinated coffee more than half the time

• Participants were followed from baseline (95-96) until the date of death or 12/31/08.

• Coffee consumption was tabulated according to a number of dietary and lifestyle factors

• Hazard rations and 95% confidence intervals for mortality associated with coffee consumption were estimated with Cox proportional hazards regression models, with person-years as the underlying time metric

Methods

• Risk estimates were presented seperately for men and women

• Multivariate models were adjusted for:– Age, BMI, race/ethnicity, level of education, alcohol

consumption, number of cigarettes smoked daily, use or nonuse of pipes or cigars, time of smoking cessation, health status , presence or absence of diabetes, marital status, level of physical activity, total energy intake, dietary consumption, vitamin supplementation , history of cancer in first degree relative and for women you of postmenopausal hormone therapy

Results

• Coffee consumption at baseline was associated with several other dietary and lifestyle factors

• As compared with persons who did not drink coffee, coffee drinkers were more likely to smoke cigarettes and consume more then 3 alcoholic drinks per day … and they consumed more red meat

Results

• Coffee drinkers also tended to have a lower level of education; were less likely to engage in vigorous activity and reported lower levels of consumption of fruits, vegetables and white meat

• However, coffee drinkers, especially women who drank coffee, were less likely to report having diabetes.

• About 2/3 of coffee drinkers reported drinking predominantly caffeinated coffee

Results

Author’s Conclusion

Evaluation

Statistics Discussion

Questions?