Coffee Consumption and Risk of Type 2 Diabetes Mellitus Among Middleaged Finnish Men and Women from

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Coffee Consumption and Risk of Type 2 Diabetes
Mellitus Among Middle-aged Finnish Men and
Women from JAMA, March 10 , 2004Vol 291, N0.
101213- 1219

• By ???

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• Effects of coffee and caffeine on CV disease ,
  HTN, neurological diseases, different types of
  cancer, homoronal changes, gallstones, renal
  stones, and DM
• Type 2 DM is largely determined by lifestyle
  factors
• In vivo, caffeine stimulates insulin secretion of
  the pancretic beta cells
• Finnish population has the highest per capita
  coffee consumption in the world with 11.3kg in
  2000

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Method

• Participants
• A prospective study from combined surveys
  conducted in 1982, 1987, and 1992 of 6974 men and
  7655 women aged 35 to 64 yrs
• Measurements
• A self- administered questionnaire including
  medical history , lifestyle
• How many cups of coffee or tea do you drink per
  day ?
• ?5 categories 0-2 cups, 3-4 cups, 5-6 cups,
  7-9 cups and 10 or more cups
• 3. BMI lt 25, 25 to lt 30 and gt30

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Result

• A total of 381 cases of type 2 DM noted during a
  mean follow-up of 12 yrs
• Older person ?less likely to drink coffee
• Higher coffee consumption ?high BMI and smoking
  and low BP, education level, light occupational
  physical activity and tea or alcohol use

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Coffee consumption and Risk of type 2 DM
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Coffee consumption and Risk of type 2 DM

• After further adjustment for BMI, SBP and
• ?the inverse association remained highly
  significant among women
• ?but in men, the risk of DM was significant
  reduced in those drinking at least 10 cups of
  coffee

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Coffee consumption and risk of type 2 DM in
subgroup analyses
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Coffee consumption and risk of type 2 DM in
subgroup analyses

• Inverse association including
• 35 to 49 and 50 to 64 yrs
• Non smokers
• Overweight participants
• Non drinkers

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Coffee consumption and risk of type 2 DM in
subgroup analyses
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Coffee consumption and risk of type 2 DM in
subgroup analyses

• More than 80 of Finnish coffee consumers used
  filtered coffee at baseline
• Men who drank pot-boiled coffee showed a 2.9
  times high risk development of DM compared with
  filtered coffee
• ?also observed among men and women combined

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Comment

• The significant inverse association between
  coffee consumption and the risk of type 2 DM was
  found in both sexes
• But, no association noted in the previous study
  in Finnish ?pot- boiled coffee before

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Comment

• Van Dam and Freskens study lancet 2002
  3601477-1478
• From large US cohorts of men and women also
  showed the long term coffee consumption and
  caffeine intake ?reduce the risk of type 2 DM
• Japanese cross sectional study comprising 1916
  men and 2704 women aged 40 to 50 yrs? inversely
  associated with the prevalence of fasting
  hyperglycemia ( gt110 mg/dl or 6.1 mmol/L)

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Comment

• Possible mechanism
• inhibition of glucose -6- phosphatase activity
  by chlorogenic acid
• Hepatic glucose -6- phosphatase ?key control site
  in the homeostatic regulation of blood glucose
  concentration
• Reduced glucose -6- phosphatase hydrolysis or its
  inhibition ?reduce plasma glucose output
• Instreptozotocin- induced diabetic rates?
  hypoglycemic effect of chlorogenic acid
• Jonston et al ?chlorogenic acid might be an
  antagonistic effect on glucose transport

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Comment

• Inhibit glucose transporters ( sodium-dependent
  glucose transporter) at the intestinal stage?
  GLP-1 and gastric inhibitory polypeptide ?low
  glucose

Diabetes Care, vol 26, No10, October 2003
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Comment

• Coffee contains magnesium(11 mg per 100g of dry
  coffee)? positive glucose tolerance and
  prevention of type 2 DM
• Significant inverse correlation between serum Mg
  and the incidence type 2 DM

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Comment

• Caffeine and ophylline are strong stimulation of
  pancreatic ß-cells
• Caffeine may increase insulin sensitivity

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Comment

• The inverse association between colffee
  consumption and the risk of DM tended to be
  stronger in women than men ?plasma estrogen,
  plasma estradiol, and sex hormone binding
  globulin levels

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Comment

• Limitaions
• Glucose tolerance test was not performed in the
  baseline and follow up surveys ?miss some
  asymptomatic and diet- treated diabetes
• Self- report fro data on coffee intake
• Residual confounding factors such as diet

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Comment

• Conclusions
• We found a strong and graded inverse relationship
  between coffee consumption and the risk of type
  2 DM among Finnish men and women ?a population
  with the highest coffee consumption in the world
• The possible mechanisms?
• ?chlorogenic acid on glucose 6- phosphatase
• ?antioxidant activity of polyphenils on
  a-glucosidase
• ?insulin secretion
• ?phytoestrogne effect
• ?Mg effect