In order to assess the interaction between alcohol intake, tobacco smoking and coffee con sumption in determining the risk of liver cirrhosis we carried out a hospital-based case-control study involving 115 patients at their first diagnosis of cirrhosis and 167 control patients consecutively enrolled in the General Hospitals of the Province of L'Aquila (Central Italy). The mean life-time daily alcohol intake (as g ethanol consumed daily) was measured by direct patient interviews, whose reproducibility was >0.80 and similar for cases and controls, as checked by interviewing the relatives of a sample of 50 cases and 73 controls. During the same patient's interview we also measured the mean consumption of coffee (daily number of cups of filtered coffee) and tobacco (life-time daily number of cigarettes smoked). A dose-effect relationship on the risk of cirrhosis was present both for alcohol intake — for which the risk was significantly increased above 100 g of daily intake — and for cigarette consumption. The latter did not however improve the goodness-of-fit of a logistic regression model including alcohol intake as covariate. By contrast, coffee consumption had a protective effect on the risk of cirrhosis and significantly improved the goodness-of-fit of such a model. Abstaining from coffee consumption determined both a significantly increased risk of cirrhosis, even for daily alcohol intake below 100 g, and a multiplicative effect with alcohol intake on this risk. In patients drinking ⩾101 g ethanol daily the relative risk increased from 5.5 (95% confidence interval: 1.4–22.0) for coffee consumers to 10.8 (95% confidence interval: 1.3–58.1) for coffee abstainers. We conclude that: (1) tobacco smoking is likely to be a faint risk factor for cirrhosis, and studies on wider patients series should be performed for confirmation; (2) coffee drinking is associated with a reduced risk of cirrhosis. Whether coffee contains some hitherto unknown protective substances, or is just a marker of other life-style or dietary protective factors, deserves further clarification.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Ainley CC, Senapati A, Brown IMH, Iles CA, et al. Is alcohol hepatotoxic in the haboon? J Hepatol 1988; 7: 85–92.
Bak AAA, Grobee DE. The effect on serum cholesterol levels of coffee brewed by filtering or boiling. N Engl J Med 1989; 321: 1432–1437.
Batey RG, Burns T, Benson RJ, et al. Alcohol consumption and the risk of cirrhosis. Med J Aust 1992; 156: 413–416.
Bouliere M, Barthet M, Berthezene P, et al. Is tobacco a risk factor for chronic pancreatitis and alcoholic cirrhosis? Gut 1991; 32: 1392–1395.
Breslow NE, Day NE. Statistical methods in cancer research, Vol. 1: The analysis of case-control studies. IARC Scientific Publication No. 32. Lyon, 1980.
Brillanti S, Barbara L, Miglioli M, Bonino F. Hepatitis C virus: A possible cause of chronic hepatitis in alcoholics. Lancet 1989 (ii): 1390–1391.
Casiglia E, Spolaore P, Ginocchi G, Ambrosio GB. Unexpected effect of coffee consumption on liver enzymes. Eur J Epidemiol 1993; 9: 293–297.
Chung HT, Lai CL, Wu PC, et al. Synergism of chronic alcoholism and hepatitis B infection in liver disease. J Gastroenterol Hepatol 1989; 4: 11–16.
Corrao G, Aricò S, Carle F, et al. A case-control study on alcohol consumption and the risk of chronic liver disease. Rev Epidemiol Santé Publ 1991; 39: 333–343.
Corrao G, Hricò S, Lepore AR, Valenti M, Torchio P, Galatola G, Tabone M, di Orio F. Amount and duration of alcohol intake as risk factors of symptomatic liver cirrhosis: A case-control study. J Clin Epidemiol 1993; 46: 601–607.
Corrao G, Carle F, Lepore AR, et al. Interaction between alcohol consumption and positivity for hepatitis C virus on the risk of liver cirrhosis: A case-control study. Eur J Epidemiol 1992; 8: 634–639.
Desmond PV, Patwardhan RV, Johnson RF, Schenker S. Impaired elimination of caffeine in cirrhosis. Dig Dis Sci 1980; 25: 193–197.
Fleiss JL. The design and analysis of clinical experiments. New York: John Wiley and Sons, 1986.
George J, Murphy T, Roberts R, Cooksley WGE, Halliday JW, Powell LW. Influence of alcohol and caffeine consumption on caffeine elimination. Clin Exp Pharmac Physiol 1986; 13: 731–736.
Grant BF, Dufour MC, Hartford TC. Epidemiology of alcoholic liver disease. Semin Liver Dis 1988; 8: 12–23.
Klatsky AL, Armstrong MA. Alcohol, smoking, coffee and cirrhosis. Am J Epidemiol 1992; 136: 1248–1257.
Leiber CS, Decarli LM, Rubin E. Sequential production of fatty liver, hepatitis, and cirrhosis in subhuman primates fed hetanol with adequate diets. Proc Nat Acad Sci USA 1975; 72: 437–441.
Mantel N. Chi-square tests with one degree of freedom: Extensions of the Mantel-Haenszel procedure. J Am Statist Ass 1963; 58: 690–700.
Mitchell MC, Hoyumpa AM, Schenker S, Johnson RF, Nichols S, Patwardhan RV. Inibition of caffeine elimination by short-term ethanol administration. J Lab Clin Med 1983; 101: 826–834.
Nalpas B, Driss F, Pol S, et al. Association between HCV infection in hepatocellular carcinoma and alcoholic liver disease. J Hepatol 1991; 12: 70–74.
Namura H, Kashiwagi S, Hayashi J, et al. An epidemiologic study of effects of alcohol in the liver in hepatitis B surface antigen carriers. Am J Epidemiol 1988; 128: 277–284.
Nanji AA, French SW. Relationship between pork consumption and cirrhosis. Lancet 1985 (i): 681–683.
Norton R, Batey R, Dwyer T. Alcohol consumption and the risk of alcohol related cirrhosis in women. Br Med J 1987; 295: 80–82.
Orrego H, Blendis LM, Blake JE. Unreliability of assessment of alcohol intake based on personal interviews in a liver clinic. Lancet 1979 (ii): 1354–1356.
Pequignot GU, Tuyns AJ, Berta JL. Ascitic cirrhosis in relation to alcohol consumption. Int J Epidemiol 1978; 7: 113–120.
Rothman KJ. The estimation of synergy or antagonism. Am J Epidemiol 1976; 103: 506–511.
Rubin E, Lieber CS. Fatty liver, alcoholic hepatitis and cirrhosis produced by alcohol in primates. N Engl J Med 1974; 290: 128–135.
Sorensen TIA, Orholm M, Benzen KD. Prospective evaluation of alcohol abuse and alcoholic liver injury in man as predictors of development of cirrhosis. Lancet 1984 (ii): 241–244.
Sorensen TIA. Alcohol and liver injury: Dose-related or permissive effect? Liver 1989: 189–197.
Statland BE, Demas TJ. Serum caffeine half-lives. Healthy subjects vs patients having alcoholic hepatic disease. Am J Clin Path 1980; 73: 390–393.
van Dusseldorp M, Katan MB, Demacker PNM. Effect of decaffeinated versus regular coffee on serum lipoproteins. Am J Epidemiol 1990; 132: 33–34.
Viani R. The composition of coffee. In: Garattini S, ed. Caffeine, coffee and health. New York: Raven Press, 1993: 17–41.
Provincial Group for the Study of Chronic Liver Disease: A. Attili (Cattedra di Fisiopatologia Digestiva, Università di L'Aquila), S. Santini, F. Bruccoleri & E. Zepponi (Laboratorio Analisi Cliniche, Ospedale Civile Tagliacozzo), G. Tullio & G. Tonietti (Cattedra di Clinica Medica, Università di L'Aquila), V. Festuccia, G. Giandomenico & G. Natali (Cattedra di Patologia Medica, Università di L'Aquila), M. Pozone, A. Giusti & F. Caione (Divisione di Geriatria, Ospedale Civile L'Aquila), M. Mariani, A. Grimaldi & A. Iannessi (Divisione di Malattie Infettive, Ospedale Civile L'Aquila), F. Marchionni, G. Del Bove Orlandi & G. Rabitti (Divisione di Medicina Generate, Ospedale Civile Avezzano), G. Sgrò & S. Cercone (Divisione di Medicina Generate, Ospedale Civile Sulmona), E. Bernardini & P. Capobianchi (Divisione di Medicina Generate, Ospedale Civile Tagliacozzo), M. Giovannone, M. Cincis & P. Caracciolo (Divisione di Medicina Generate, Ospedale Civile Castel di Sangro), L. Colitti & A. Biocca (Divisione di Medicina Generate, Ospedale Civile Pescina), C. Ercole, C. Miccoli & C. Rapone (Scuola di Specializzazione in Patologia Clinica, Università di L'Aquila), S. Necozione & G. Pantaleo (Centro Interdipartimentale di Epidemiologia, Università di L'Aquila)
About this article
Cite this article
Corrao, G., Lepore, A.R., Torchio, P. et al. The effect of drinking coffee and smoking cigarettes on the risk of cirrhosis associated with alcohol consumption. Eur J Epidemiol 10, 657–664 (1994). https://doi.org/10.1007/BF01719277
- Alcohol consumption
- Coffee consumption
- Tobacco smoking