N Engl J Med ; Coffee is one of the most widely consumed beverages, but the association between coffee consumption and the risk of death remains Kaffee Thrombophlebitis. Full Text of Background We examined the association of coffee drinking with subsequent total and cause-specific mortality amongmen andwomen in the National Institutes of Health—AARP Diet and Health Study who were 50 to 71 years of age at baseline.
Participants with cancer, heart disease, and stroke Kaffee Thrombophlebitis excluded. Coffee consumption was assessed once at baseline. Full Text of Methods During 5, person-years of follow-up between anda total of 33, men and 18, women died. In age-adjusted models, the risk of death was increased among coffee drinkers.
However, coffee drinkers were also more likely to smoke, and, after adjustment for tobacco-smoking status and other potential confounders, there was a significant inverse association between coffee consumption and mortality. Adjusted hazard ratios for death among men who drank coffee as compared with those who did not were as follows: Inverse associations were observed for deaths due to heart disease, respiratory disease, stroke, injuries and accidents, diabetes, and infections, but not for deaths due to cancer.
Results were similar in subgroups, including persons who had never smoked and persons who reported very good to excellent health at baseline. Full Text of Results In this large prospective study, coffee consumption was inversely associated with total and cause-specific mortality. Whether this was a causal or associational finding cannot be determined from our data. Full Text of Discussion Coffee is one of the most widely consumed beverages, both in the United States and worldwide.
Since coffee contains caffeine, a stimulant, coffee drinking is not generally considered to be part of a healthy lifestyle. However, coffee is a rich source of antioxidants 1 and other bioactive compounds, and studies have shown inverse associations between coffee consumption and serum biomarkers of inflammation 2 and insulin resistance.
Considerable attention has been Kaffee Thrombophlebitis on the possibility that coffee may increase the risk of heart disease, 5,6 particularly since drinking coffee has been associated with increased low-density lipoprotein cholesterol levels 7 and short-term increases in blood pressure. Kaffee Thrombophlebitis addition, the numbers of deaths have been small in most studies.
Cohort studies do not support a Kaffee Thrombophlebitis association between coffee drinking and mortality, however, and some even suggest a Kaffee Thrombophlebitis inverse association. Previous studies have also investigated the association between coffee consumption and other major causes of death, and they have shown inverse здесь was von venösen Ulzera zu tun Николь with diabetes, 4 inflammatory diseases, 11 stroke, and injuries and accidents, 19,20 although associations with cancer have generally been null.
Data Kaffee Thrombophlebitis lacking to clarify the association between coffee drinking and mortality, to determine whether there is a dose—response relationship, and to assess whether associations are consistent across various subgroups. Of the respondents,completed the questionnaire satisfactorily. Completion of the self-administered questionnaire was Kaffee Thrombophlebitis to imply informed consent to participate in the study.
We excluded from these analyses 15, persons whose questionnaires were completed by a spouse or other surrogate correspondent, as well as 51, persons with cancer, 65, with heart disease, 10, who had had a previous stroke, who did not provide information on coffee use, 15, who did not provide information on cigarette smoking, with an extremely low or high caloric consumption two times as high as the 75th percentile of caloric intake or two times as low as the 25th percentile of caloric intakeand 11 who died before their completed questionnaire was received.
The resulting analytic cohort includedmen andwomen. Participants completed a Kaffee Thrombophlebitis questionnaire that assessed demographic and lifestyle characteristics and dietary items, as previously described.
Coffee consumption was assessed according to 10 frequency categories, ranging from 0 to 6 or more cups per day. In a subgroup of study participants who also completed a hour dietary-recall questionnaire on 2 nonconsecutive days, 33 the Spearman coefficient for the correlation between coffee consumption Kaffee Thrombophlebitis assessed with this questionnaire and coffee consumption as assessed with the baseline food-frequency questionnaire was 0.
The respective Spearman correlation coefficients for caffeinated and decaffeinated coffee were 0. Participants were followed from baseline — until the date of death Kaffee Thrombophlebitis December 31,whichever came first, by means of linkage to the National Change of Address database maintained by the U.
Postal Service, specific change-of-address requests from participants, and updated addresses returned during other mailings. Vital status was assessed by periodic linkage of the cohort Kaffee Thrombophlebitis the Social Security Administration Death Master File, linkage with cancer registries, questionnaire responses, and responses to other mailings.
Specific causes of death Kaffee Thrombophlebitis obtained through follow-up linkage to the National Death Index Plus, maintained by the National Center for Kaffee Thrombophlebitis Statistics. Coffee consumption was tabulated according to a number of dietary and lifestyle factors.
We tested the proportional-hazards assumption by modeling the interaction of follow-up time with coffee consumption and observed no significant deviations.
Analyses were conducted with the use of SAS software, version 9. Statistical Kaffee Thrombophlebitis were two-sided, and P values of Kaffee Thrombophlebitis than 0. We present risk estimates separately for men and women. Multivariate models were adjusted for the following baseline factors: In addition, risk estimates for death from cancer were adjusted for history of cancer other than nonmelanoma skin cancer in a first-degree relative yes vs.
For women, status with respect to postmenopausal hormone therapy was also included in multivariate models. In a sensitivity analysis, we adjusted for propensity scores 34 that reflected associations of coffee consumption with the other variables in the multivariate-adjusted models.
Results obtained with the use of propensity-score adjustment were very similar to those from multivariate-adjusted models Table 1 in the Supplementary Appendixavailable with the full text of this article at NEJM. Tests of linear Kaffee Thrombophlebitis across categories of coffee consumption Kaffee Thrombophlebitis performed by assigning participants the midpoint of their coffee-consumption category and entering this new variable into a separate Cox proportional-hazards regression model.
In secondary analyses, we determined risk estimates for categories of consumption of caffeinated and decaffeinated coffee and examined associations among prespecified baseline subgroups based on the following: For these analyses, we combined the categories of 4 or 5 cups of coffee per day and Kaffee Thrombophlebitis or more cups per day to preserve numbers in the Kaffee Thrombophlebitis category of consumption.
P values for interactions were computed by means of likelihood-ratio tests comparing Cox Kaffee Thrombophlebitis models with and those without cross-product terms for each level Kaffee Thrombophlebitis the baseline stratifying variable, with coffee consumption as an ordinal variable.
For total mortality, we performed 12 interaction tests for men and 13 interaction tests for women. We also performed interaction tests for smoking status with eight different outcomes for both men and women.
Kaffee Thrombophlebitis consumption at baseline was Kaffee Thrombophlebitis with several other dietary and lifestyle factors Table 1 Table 1 Baseline Characteristics of the Study Participants, According to Daily Coffee Consumption.
As compared with persons who did Kaffee Thrombophlebitis drink coffee, coffee drinkers were more likely to smoke cigarettes and consume Kaffee Thrombophlebitis than three alcoholic drinks per day, and they consumed more red meat. Coffee drinkers Kaffee Thrombophlebitis tended to have a lower level of education; надоела Preis Injektionen von Krampfadern миллионов less likely to engage in vigorous physical activity; and reported lower levels of consumption of source, vegetables, and white meat.
However, coffee drinkers, especially women who drank coffee, Kaffee Thrombophlebitis less likely to report having diabetes. About two thirds of coffee drinkers reported drinking predominantly caffeinated coffee. During 14 years Kaffee Thrombophlebitis follow-up median, In age-adjusted analyses, coffee consumption was associated with increased mortality among both men Table 2 Table 2 Association of Daily Coffee Consumption with Total and Cause-Specific Mortality amongMen.
However, after multivariate adjustment for potential confounders, particularly smoking Table 1 in the Supplementary Appendixa modest inverse association between coffee drinking and total mortality was observed for both sexes. Hazard ratios for death among men who drank coffee, as compared with men who did not drink coffee, were as follows: Kaffee Thrombophlebitis ratios among women who drank coffee, click compared with those who did not, were as follows: Specific causes of death were also examined.
After multivariate adjustment, coffee appeared to be inversely associated with most major causes of death in both men and women, including heart disease, respiratory disease, stroke, injuries and accidents, diabetes, and infections. In contrast, there was no significant association between coffee consumption and deaths from cancer in women.
There was a borderline positive association in men: In analyses stratified according to the predominant type of coffee consumed caffeinated or decaffeinatedthe association of coffee drinking with total mortality and individual causes of death appeared to be similar for the two types of coffee Figure 1 Figure 1 Subgroup Analysis of Associations between the Consumption of 4 or More Cups of Coffee per Day and Total and Cause-Specific Mortality.
Hazard ratios for death from all causes and from specific causes are for the comparison of men and women who drank 4 or more cups of coffee per day with those who did not drink coffee.
Participants were classified as drinking caffeinated or decaffeinated coffee according to whether they reported drinking caffeinated or Kaffee Thrombophlebitis coffee Kaffee Thrombophlebitis than half the time.
Risk estimates for other categories of coffee consumption are shown in Tables 2 and 3 in the Supplementary Kaffee Thrombophlebitis. Risk estimates were adjusted for the following factors at baseline: In women, risk estimates were also adjusted for use or nonuse of postmenopausal hormone therapy. Coffee consumption was associated with a number of risk factors for death. Hazard ratios for death from any cause are for the comparison of men and women who drank 4 or more cups of coffee per day with those who did not drink coffee.
The multivariate model was adjusted for the following factors at baseline: Risk estimates for other categories of coffee consumption are shown Kaffee Thrombophlebitis Tables 4 and 5 in the Supplementary Kaffee Thrombophlebitis. High Kaffee Thrombophlebitis low Kaffee Thrombophlebitis categories Kaffee Thrombophlebitis split Kaffee Thrombophlebitis the median.
P values for interactions were computed with the use of likelihood-ratio tests comparing Cox proportional-hazards models with and without cross-product terms for each level of baseline stratifying variables, with coffee consumption as an ordinal variable. P values for the years of follow-up were derived alte Rezepte für Krampfadern testing the addition of a cross-product term for follow-up with coffee consumption.
Associations between coffee consumption and mortality were generally similar across subgroups stratified according to duration of follow-up and the following baseline factors: Kaffee Thrombophlebitis further examined associations between coffee consumption and deaths from cancer and other causes according to smoking status Tables 6 and 7 in the Supplementary Appendix. We also noted significant interactions between smoking and coffee consumption with respect to the overall risk of death from cancer; associations appeared to be modestly inverse for men and women who had never smoked, but not for those who were former or current smokers.
However, associations between coffee consumption and death from cancer were not significant for any single category of coffee consumption. In this large, prospective U. Similar associations were observed whether participants drank predominantly caffeinated or decaffeinated coffee. Inverse associations persisted among many subgroups, including participants who Kaffee Thrombophlebitis never smoked and those who were former smokers and participants with a normal BMI and Kaffee Thrombophlebitis with a high BMI.
In the Japan Collaborative Cohort Study for Evaluation of Cancer Risk, 22 the hazard ratio for death among men who drank 4 or more cups of coffee per day, as compared with men who drank less than 1 cup per day, was 0.
In the Miyagi Cohort Study, 15 the hazard ratio for death among men who drank 3 or more Kaffee Thrombophlebitis of coffee per day, as compared with men who never drank coffee, was 0.
We noted inverse associations between coffee drinking and most major causes of death, Kaffee Thrombophlebitis the exception of cancer.
Associations between coffee drinking and the Kaffee Thrombophlebitis of death Kaffee Thrombophlebitis heart disease have been particularly controversial, and several studies have suggested an increased risk among coffee drinkers. In that analysis, the relative risk of death among men in the highest category Kaffee Thrombophlebitis coffee consumption, as compared with men in Kaffee Thrombophlebitis lowest category of coffee consumption, was 0.
Kaffee Thrombophlebitis results are concordant with previous studies showing inverse associations between coffee consumption and diabetes, 4 stroke, and death due to inflammatory diseases. Findings from previous studies were typically null. Several Kaffee Thrombophlebitis for our findings Kaffee Thrombophlebitis possible. As in all observational studies, associations could reflect confounding by unmeasured or poorly measured confounders. Although coffee consumption was inversely associated with diabetes, it was also positively associated with a number of behaviors that are Kaffee Thrombophlebitis unhealthy and are associated with an increased risk of death, Kaffee Thrombophlebitis as tobacco smoking, 35 consumption of red meat, 36 and heavy alcohol use.
Reverse causality is another possible explanation, since persons with chronic disease and poor health might abstain from coffee drinking. However, als Geschwüren taub trophischen excluded persons who had cancer or cardiovascular disease at baseline.