Coffee and the prevention of Type 2

diabetes

The Epidemiological Evidence

Edith Feskens, edith.feskens@wur.nl

Organs involved in glucose metabolism

Annual Coffee use per capita (kg)

1 Finland 12.0 kg

2 Norway 9.9 kg

3 Iceland 9.0 kg

4 Denmark 8.7 kg

5 Netherlands 8.4 kg

6 Sweden 8.2 kg

7 Switzerland 7.9 kg

8 Belgium Luxembourg 6.8 kg

9 Canada 6.5 kg

10 Bosnia and Herzegovina 6.2 kg

22 Spain 4.5 kg

23 Estonia 4.5 kg

24 Portugal 4.3 kg

25 United States 4.2 kg

1st Cohort study on Coffee and T2DM

Coffee and Risk of T2DM (Huxley ea 2009)

Dose-response in Meta-Analysis Huxley ea

(2009)

Coffee and T2DM risk factors

Wu et al 2005: associations with lower C-peptide, especially in overweight/obese

Williams et al 2008: associated with higher adiponectin, and lower levels of inflammatory markers

Bidel et al 2008: effect higher in those with high serum gammaGT

Low risk in high coffee drinkers in the

Strong Heart Study 2011

Zhang et al, 2011

Coffee not associated with more chronic disease, in any case with lower TDM risk

Boiled coffee from Norway works as well…

A dose-responsealso in China…

Is it the caffeine?

Not likely, decaf is also associated with lower risk:

Huxley ea 2009

Is it another coffee constituent?

Van Dam, 2005

Coffee, T2DM and dietary antioxidant

capacity – The Rotterdam Study

Coffee consumption (cups/day)

≤ 2 >2 – 3 >3 – 4 >4

Age (y) 70.0±8.0 68.5±7.7 67.3±7.3 64.4±6.8

Men (%) 34.4 36.5 39.9 49.6

Body mass index (kg/m²) 26.1±3.6 26.1±3.5 26.5±3.6 26.3±3.6

Waist circumference (cm)

Men

Women

93.2±9.5

86.9±11.0

93.9±8.9

86.6±11.1

94.0±9.2

87.3±11.0

94.6±9.4

85.9±11.3

Results – The Rotterdam Study (2)

Coffee consumption (cups/day)

≤ 2 >2 – 3 >3 – 4 >4

Smoking status (%)

Current

Former

Never

12.4

43.1

44.5

17.3

43.3

39.3

21.5

44.5

34.0

38.1

41.1

20.8

Alcoholic drinks (%)

0 g/day

>0-10 g/day

>10-20 g/day

>20 g/day

24.3

47.7

11.2

16.7

18.4

45.9

18.3

17.4

18.0

47.1

16.0

18.9

18.2

42.3

17.1

22.4

Diet prescription (%) 12.0 12.3 10.1 8.4

Educational level (%)

Low

Moderate

High

35.3

50.5

14.2

33.9

54.4

11.8

33.9

56.3

9.8

34.2

53.4

12.5

Family history of diabetes (%) 27.4 27.8 27.4 28.2

What is dietary pattern?

Results - The Rotterdam Study (3)

Coffee consumption (cups/day)

≤ 2 >2 – 3 >3 – 4 >4

Energy (kcal/day) 1896 1919 1981 2077

Carbohydrates (energy-%) 44.1±7.3 43.6±6.7 43.4±6.5 42.8±6.9

Protein (energy-%) 16.6±3.0 16.8±3.0 16.8±3.0 16.7±3.1

Fat (energy-%) 36.0±6.3 36.1±6.1 36.2±6.0 36.5±6.2

Saturated fat (energy-%) 14.2±3.4 14.3±3.2 14.3±3.1 14.5±3.1

Fibre (g/day) 16.2±5.6 16.5±5.1 16.8±4.6 17.7±5.1

Tea (cups/day)* 3.5 3.0 3.0) 2.0

Total FRAP score (mmol/day) 15.2±3.9 18.1±3.3 21.0±3.0 25.8±4.8

What is FRAP?

FRAP=Ferric iron Antioxidant Reducing Power

FRAP assay: method that assesses antioxidant capacity of individual food items by measuring the ability of antioxidants in food items to reduce ferric iron (Fe3+) to ferrous iron (Fe2+)

2010: Food table by Rune Blomhoff’s group (Oslo, Norway)

Food table for Rotterdam Study prepared with Elizabeth Devore (US)

Contribution by coffee 51%; tea 17%; oranges etc <4%

Relative Risks coffee according to FRAP

adjustment – The Rotterdam Study

0.00

0.50

1.00

1.50

RR

Adjusted (p-trend=0.03)

Incl FRAP (p-trend=0.96)

≤ 2 ≥2 -3 ≥3-4 > 4

Coffee (cups per day)

Adjusted RRs for dietary FRAP scores

0.00

0.50

1.00

1.50

RR

Total FRAP (p-trend<0.01)

FRAP wo Coffee/Tea p=0.05

Q1 Q2 Q3 Q4

Interpretation Rotterdam data

Again, coffee consumption is independently associated with a lower risk of type 2 diabetes

Dietary antioxidant activity was also inversely associated with the risk of type 2 diabetes

Mainly due to the contribution of coffee (and tea)

Acknowledgment

Thanks to all collaborators and funders!

Collaborators: Rob van Dam, Anouk Engelen, Anneleen Kuijsten, Truus van Woudenbergh and various MSc students;

Rotterdam Study: Jacqueline Witteman,Frank van Rooij, Oscar Franco and Albert Hofman;

Funding: ao. EU-FP6 INTERACT project